Registration Form Fill in your details to register your pet. Fields marked with a * are required and will need to be completed in order for you to submit your form. Your Details: Title:* First Name:* Surname:* Address:* Post Code:* E-mail:* Phone Number(s):* Animal Details: Name:* Species:*(dog,cat,other) Breed:* D.O.B/Age:* Colour:* Last Vaccination Date: Microchip Number: Sex:—Please choose an option—MaleNeutered MaleFemaleNeutered Female Do you have Pet Insurance?:—Please choose an option—YesNo Which Company?: To your knowledge, is your pet allergic to any medication?:—Please choose an option—YesNo Please specify?: Has your pet received any Veterinary treatment in the past 3 months?:—Please choose an option—YesNo Please specify?: Previous Vet's name and address: How did you find out about us?: Please note it is your responsibility to ensure your pet is under control at all times in the waiting area. Dogs should be kept on leads at all times and cats should be contained in an appropriate carrier. The Terms of Business and Privacy Notice are available to view on our website and on the reception desk of the surgery. By registering your animal you are agreeing with the Terms of Business I agree for CSVC Ltd to keep and use my personal information in accordance with their Privacy Notice. I agree to be contacted by phone, email or post with relevant information about my pets health, welfare and well-being. I am aware that I can withdraw this consent at any time by contacting the practice staff with my request.