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Registration Form for Georgian College Wellness Clinic – May 14 and 15

Comments

This field is for validation purposes and should be left unchanged.

Please fill out all the following information to the best of your ability. If you have more than one pet being registered please fill out a NEW registration form for each pet. A Team member will reach out to you in the near future to finalize your registration and collect payment for services. Thank you.

Animal Owner's Name(Required)

First Last

Animal Owner's Address(Required)

Street Address Address Line 2 City Province ZIP / Postal Code

Daytime Phone Number(Required)

Secondary Phone Number

Email(Required)

Species(Required)

Cat

Dog

Animal's Name(Required)

Animal's Age(Required)

Please indicate your animals age with a number, followed by if it is months or years

Breed(Required)

Colour(Required)

Sex(Required)

Male

Male Neutered

Female

Female Spayed

Unsure

Please advise us of any medical conditions past or present (seizures, skin condition, heart murmur etc ..)(Required)

If your pet has no on going medical conditions you can indicate none in the above field.

Please advise us of any medications or suplimentations your pet is currently taking (eg. Heartworm meds, antibiotics, ear meds, probiotics) and the frequency that they are given (eg. Daily, every month, only when needed).(Required)

If your pet is currently not on any medications indicate as none in the above field.

Services requested(Required)

Exam cost = $60

Rabies cost (core vaccine) = $33

DA2PP cost (core vaccine) = $33

Leptospirosis cost (core vaccine) = $33

Bordetella (Kennel Cough) cost = $33

Microchip cost = $36

Heartworm & Tick testing cost = $80

Exam is charged for all appointments.

Services requested(Required)

Exam = $60

Rabies (core vaccine) = $33

FVRCP (core vaccine) = $33

Feline Leukemia = $33

Microchip = $36

Exam is charged for all appointments.

Subsidy Options

Would like to discuss subsidy options

The Ontario SPCA does provide reduced pricing for those individuals who require further financial support. If you are in need of further support please choice this option and a Team member will follow up with you.

Please provide us with the name of your Regular Veterinarian or Veterinary Clinic(Required)

If you do not have a regular veterinary clinic please indicate as none in the above field.

Does your cat meet the "ideal" body condition as per the charts linked below?(Required)

Yes

No

Unsure

Does your dog meet the "ideal" body condition as per the charts linked below?(Required)

Yes

No

Unsure

Consent(Required)

I acknowledge that this appointment request is for the Wellness clinic at Georgian College.

Links

© 2026 Ontario SPCA and Humane Society.

Charitable Business # 88969-1044-RR0002

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