Barton Lodge Vets - 1 Midland Road, Hemel Hempstead, Hertfordshire HP2 5BH, United Kingdom
Barton Lodge
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Barton Lodge Vetinary Centre Contact Details
Register as a new client

Register as a new client

Please fill in the form below and click submit for it to be sent to us via email. Fields marked with an asterisk (*) are required fields.

How many pets do you wish to register? *

Title: *

Name: *

Surname: *

Address: *

Postcode: *

Home tel no: *

Work tel no:

Mobile tel no:

What is your e-mail address?



Pet's name: *

Pet's D.O.B. / approx age: *

Species (dog / cat / rabbit etc): *

Breed: *

Colour: *


Sex: *
Male Female

Spayed / Castrated: *
Yes No

Insurance company:


Microchip: *
Yes No

ID chip no:



Previous Vet's name:

Previous Vet's phone number:

If your pet was registered under a previous address, please supply this address:


Please confirm that you are happy for us to contact your previous practice in order to obtain your pets records.

Yes, you have my permission to contact my previous practice

Where did you hear about us?


What has prompted registration with us?

Recommendation Location Website

Would you like someone to contact you regarding a free nurse health check for your pets?

Yes No

If so, what is the best time for someone to contact you and on which number?






 

Barton Lodge Vetinary Centre
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Barton Lodge Veterinary Centre Ltd - 1 Midland Rd Hemel Hempstead Hertfordshire HP2 5BH Tel. 01442 216048
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