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Registration Form for Durham Community Health Clinic – March 28th and 29th

This field is for validation purposes and should be left unchanged.
Animal Owner's Name(Required)
Animal Owner's Address(Required)
Species(Required)
Please indicate your animals age with a number, followed by if it is months or years
Sex(Required)
If your pet has no on going medical conditions you can indicate none in the above field.
If your pet is currently not on any medications indicate as none in the above field.
Services requested(Required)
*Exam included. Exam charged for general wellness exams with no vaccines. Any medications recommended for your pet may be paid for at the conclusion of the exam.
Services requested(Required)
*Exam included. Exam charged for general wellness exams with no vaccines. Any medications recommended for your pet may be paid for at the conclusion of the exam.
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)
Does your dog meet the "ideal" body condition as per the charts linked below?(Required)
Do you receive government subsidy, or have an Indigenous status card?(Required)
Max. file size: 50 MB.
Any of the following qualifies for subsidy: CPP-D (Canada Pension Plan), ODSP (Ontario Disability Supplement Program), OW (Ontario Works), Indigenous status, GIS (Guaranteed Income Supplement), OAS (Old Age Security). Please upload any form/statement/screenshot of the above with your full name and address visible.
Consent(Required)

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