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I am happy to be sent reminders by (tick all that apply)*
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I have read and agree to the Terms and conditions of business and Privacy policy


This form is able to register one pet only.  If you have multiple pets, please fill out the form for one of them and tick the box at the bottom.  I will then contact you to register the others.

Species
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Gender
Insured?
If yes, please specify company
I give consent for you to contact my previous vets for my pet's medical history
I have other pets*
 
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