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Register your pet

Register your pet

Please fill in the form below and click submit for it to be sent to us via email. Fields marked with an asterisk (*) are required fields.

Personal details

Title
First name
Surname
Address
Postcode For example B63 2DS

Contact details

Please enter at least one telephone number or an email address
Telephone (home)
Telephone (mobile)
Telephone (business)
Email
Are you happy for us to contact you from time to time by text/email?
- Yes, I am happy to be contacted by Moor Cottage Veterinary Hospital

Your pet

Pet's name
Age
Species (e.g. cat, dog, horse, rabbit)
Breed
Colour
Sex
- Male
- Female
Neutered
- Yes
- No
Date of last vaccination
Date of last worming
Microchip number (if applicable)
Insurance company (if applicable)
Name of previous veterinary practice
Phone number of previous veterinary practice
Do you have additional pets you wish to register?
- Yes, please contact me for their details
How did you hear about us?
- Former Client
- Practice signs
- Yellow Pages
- Local newspaper
- Website
- Recommendation
- Other
If Other then please tell us here
Would you like us to contact you about a query you have?
- Yes
- No
If yes, please let us know when and how to contact you

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