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Welcoming new clients - Extended hours Monday to Thursday

Exotic Pet Health History Form

If your pet is a new patient at Queensway West Animal Hospital, please fill out our Exotic Pet Health History Form using the online form below. If you are unable to do so, please download, print, and fill out the PDF using the link below and bring it with you to your appointment.

Option 1

Complete Online

Complete and submit the online form below.

Option 2

Download & Print

If you prefer, download and print the form.

Download Health History Form

Exotic Pet Health History Form

Owner Information

Emergency Contact

Health History

By submitting this form, I hereby authorize Queensway West Animal Hospital to render medical care for my pet(s) as deemed necessary by the veterinarian. I understand that no guarantee can be given to the outcome of treatments and take it as my responsibility to comprehend any risks involved. I agree to pay for the cost of all services to which I consent to by written or verbal estimate. I understand that a deposit is required before diagnostics and treatments can be initiated and that payment in full is required prior to discharge of patient from Queensway West Animal Hospital.

Owner Information

Emergency Contact

Health History

Temperature Range
By submitting this form, I hereby authorize Queensway West Animal Hospital to render medical care for my pet(s) as deemed necessary by the veterinarian. I understand that no guarantee can be given to the outcome of treatments and take it as my responsibility to comprehend any risks involved. I agree to pay for the cost of all services to which I consent to by written or verbal estimate. I understand that a deposit is required before diagnostics and treatments can be initiated and that payment in full is required prior to discharge of patient from Queensway West Animal Hospital.

Owner Information

Emergency Contact

Health History

By submitting this form, I hereby authorize Queensway West Animal Hospital to render medical care for my pet(s) as deemed necessary by the veterinarian. I understand that no guarantee can be given to the outcome of treatments and take it as my responsibility to comprehend any risks involved. I agree to pay for the cost of all services to which I consent to by written or verbal estimate. I understand that a deposit is required before diagnostics and treatments can be initiated and that payment in full is required prior to discharge of patient from Queensway West Animal Hospital.

New Patients Welcome

Our team of Kanata veterinarians provides the personalized medical care your pet deserves. Get in touch today to book your companion's first appointment.

Contact Us

Contact Call (613) 271-8387