Demerger registration - Rutland Vets

Thank you for keeping your small animals with Rutland/Kings Veterinary Centre.

Please fill in the below information to ensure that we correctly register your animals with us.

Which branch would you like to be registered with?(Required)

This will be your primary branch however you can still attend other branches where needed

Name(Required)

Prefix First Last

Address(Required)

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Phone number(Required)

Alternative phone number

Additional account members

For GDPR purposes, we can only discuss your pets details with people that are named on the file. This includes medication collection and appointments

Is there anyone else you would like to be named on the account?

Yes

Name

Prefix First Last

Phone

Relationship to your pet

Pet details

Name

Breed

DOB/age

Colour

Sex

Male

Male neutered

Female

Female neutered

Date of last vaccination

Microchip number

Would you like to add another pet?(Required)

Yes

Pet 2

Name

Breed

DOB/age

Colour

Sex

Male

Male neutered

Female

Female neutered

Date of last vaccination

Microchip number

Would you like to add another pet?

Yes

Pet 3

Name

Breed

DOB/Age

Colour

Sex

Male

Male neutered

Female

Female neutered

Date of last vaccination

Microchip number

Would you like to add another pet?

Yes

Pet 4

Name

Breed

DOB/age

Colour

Sex

Male

Male neutered

Female

Female neutered

Date of last vaccination

Microchip number

Would you like to add another pet?

Yes

Pet 5

Name

Breed

Colour

DOB/age

Sex

Male

Male neutered

Female

Female neutered

Microchip number

Date of last vaccination

GDPR preferences

Please tick below if you are happy for us to send you appointment/treatment/visit reminders(Required)

SMS

Post

Phone

Please tick below if you are happy for us to send you our newsletter and occasional relevant information(Required)

SMS

Post

Phone

Do not contact

Terms and conditions

Please take some time to read through the terms and conditions and privacy policy below. Some of the details vary from large animal accounts so it is important that you have familiarised yourself with these

Terms and conditions(Required)

I have read and understand the terms and conditions

I have read and understand the privacy policy

Terms and conditions