New Client Form "*" indicates required fields * required fields Terms of Trade Our terms are strictly cash, unless prior credit arrangements have been made and approved by St Aubyn Veterinary Clinic. If accounts are not paid, we may charge you interest, legal fees and all costs associated with the recovery of any debt. You must be 18 years or over to open an account with us. Proof of age is required. IdentificationProof of ID*Accepted file types: jpg, pdf, doc, docx, gif, png, Max. file size: 5 MB.We ask to see one form of identification (driving licence, passport, 18+ card etc).Your DetailsFull Name – Mr, Mrs, Miss, Ms, Other*Trading Name (Company) / Known asStreet Address*PostcodePostal Address (If different from above)If a PO Box is given then we must have a physical address.PostcodeTelephone Number*Email*Date of Birth* Day Month Year Secondary Contact or Emergency Contact Name*Secondary Contact or Emergency Contact Number*Relationship*How did you hear about us?Choose OneNewspaperRadioWebsiteFacebookFriendWork ColleagueYellow PagesOtherPromotional Materials Tick this box if you do not wish to receive any promotional material via email.Monthly Statement Tick this box if you would like to receive your monthly statement via email.Consent – Previous Animal Histories* I give permission for St Aubyn Vets to request any animal histories from my previous veterinarian.Previous veterinarian name and contact number:*If not applicable please state N/A.Terms and ConditionsPayment is required at the time of the clinic visit or upon patient discharge. We accept the following payment methods: Cash, EFTPOS, Visa, and Mastercard. Any request to charge to an account must be arranged in advance and approved in writing by management. If accounts are not paid, we may charge you interest, legal fees and all costs associated with the recovery of any debt.Consent* By ticking this box I certify that all information provided is correct and I have read and understand New Plymouth Vets Terms of Trade and Terms and Conditions.Companion Animal – Pet 1Name*Type – Dog/Cat*Breed*Colour*Sex – Male/Female*MaleFemaleAge / DOB*De-sexed*YesNoMore Animals Add more animals Companion Animal – Pet 2NameType – Dog/CatBreedColourSex – Male/FemaleMaleFemaleAge/DOBDe-sexedYesNoCompanion Animal – Pet 3NameType – Dog/CatBreedColourSex – Male/FemaleMaleFemaleAge/DOBDe-sexedYesNoPhoneThis field is for validation purposes and should be left unchanged. Δ