New Client Consent Form

CLIENT INFORMATION

How did you hear about us?




How would you like to be contacted in regards to your pets' health care? *


PET INFORMATION

Tell us about your pet(s) *

 
Name
 
Feline/Canine Breed Colour DOB/Age Sex
 Pet #1 
 Pet #2 
 Pet #3 
 Pet #4
 Pet #5

PERSONAL INFORMATION CONSENT

At Cranston Veterinary Hospital we respect your right to privacy and will not collect, use or disclose any personal information regarding you and your pet without your consent. The information we seek from you is obtained so that we can provide a high quality of veterinary service and ensure that you are fully aware of our actions. We may use the information provided to contact you, including electronic communications, to assist in the health care of your pet and to reunite you with your pet in the event that they become lost.

 

In all cases, we will only disclose personal information about you and your pet in circumstances where we believe that it will be beneficial to the continued care and good health of your pet, such as a referral to a specialist or emergency veterinary facility.

 

Please indicate below that you will permit us to disclose personal information in those situations.

 

Should you have any questions regarding our collection, use or disclosure of your personal information, please contact Dr. Martin Baer.
 

CONSENT FOR COMMUNICATION & MEDIA USE

The Canadian Anti-Spam Legislation (“CASL”) prohibits the sending of any electronic messages that are commercial in nature unless the sender has received the recipients' express consent prior to sending the message. Our practice therefore requires your written consent to send you any electronic messages. While most of our communications are related to your pet’s health, some may contain commercial activities such as promotions, special events, or fundraising activities. Please note that if you do not consent, you will not receive ANY communications from our practice on any matter.
 

We also like to feature patients on our social media account(s), whether it be a success story, an interesting visit or the animal is just too cute not to. For us to responsibly take these videos and/or pictures we need to be granted your permission to use them on our social media account(s). Please keep in mind that your consent can be revoked at any time, but images and videos used during active consent will remain, though no further use of the images or videos will take place. A removal request can be made and will be reviewed, depending on the video and/or image we will try and remove it as requested but, in some cases, removal will not be possible, so please bear that in mind when consenting.

 

Please indicate what forms of communication are allowed: *

 

Note that phone calls must be allowed as that will always be the first contact method used in an emergency. Also, if you opt-out of email, you will not receive invoices, estimates, or reminders.

A. Service Communications
(These are used for appointment reminders, updates about your pet’s care, or billing-related matters.)
 

Print
Email
SMS/Text
Phone Calls


B. Marketing & Promotional Communications
(These are optional and include educational materials, newsletters, promotions, and social media use.)
 

Newsletter
Use of Pictures/Videos
Today
Please verify that you are human *