New Client Registration Form Click Here to Register New Client Registration Form Full Name * First Name Last Name Email * Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone Number * Message * Horse Details Full Name Stable Name * Passport Number Microchip Number Breed * Colour * Gender * Mare Gelding Stallion Colt Age/DOB Location/Address of horse * Horse 2 Details Full Name Stable Name Passport Number Microchip Number Breed Colour Gender Mare Gelding Stallion Colt Age/DOB Location/Address of Horse Horse 3 Details Full Name Stable Name Passport Number Microchip Number Breed Colour Gender Mare Gelding Stallion Colt Age/DOB Location/Address of Horse Horse 4 Details Full Name Stable Name Passport Number Microchip Number Breed Colour Gender Mare Gelding Stallion Colt Age/DOB Location/Address of Horse Further Information Do you give permission for the yard to make appointments for you? Yes No Is your Horse/s insured? * Yes No If so, who is the provider? Do you provide consent for us to contact your previous veterinary practice for clinical history? * Yes No If yes, please provide practice details below. * Communication Preferences Allow vaccination reminders by (please select) Text E-mail Post None Allow appointment reminders by (please select) Text E-mail Post None Allow us to contact you about events we are hosting, seasonal promotions we are offering or to send you guidance on veterinary health or care of your horse (please select) Text E-mail Post None Allow invoices/statements to be sent via email? Text E-mail Post None INFORMATION AND DATA Iain McKenzie Equine Practice Ltd. would like to keep information provided by you on file, for the sole use of the company, directly or indirectly, and will not pass or sell your information onto third party marketing companies. We shall take all reasonable precautions to preserve the integrity and prevent any corruption or loss, damage or destruction of the data and information. When registering as a client to our practice you accept our privacy policy and terms and conditions, which can be found on our website. I accept the Terms and Conditions Thank you!
