Eastwood Veterinary Clinic – Ballarat
03 5331 1918
81 Mair Street East, Ballarat

Register a new pet with us.

Register your pets online and your details will already be in our system when you visit our clinic here at Eastwood Vets Ballarat. It's a handy time saver for you.

**Currently we are experiencing a higher than normal demand for appointments. This means that we are currently at capacity and are unfortunately unable to take on new clients. We value the ongoing support of our existing clientele so this measure was put into place to be able to provide the best care possible in these difficult times.

Contact Details

First Name:

Surname:

Additional Contact:

Address:

Phone (H)

Mobile:

Work:

Email Address

Pet Details

Pet Name:

Cat/Dog/Other:

Breed:

Colour:

Sex

Male Female

Desexed

Yes No

Microchip ID:

(This could also be your pets Microchip number)

Date of Birth:

Date of Last Vaccination:

Type of Vaccination:

(Please type in what was on your last vaccination record - e.g. 15 June 2022 Protech C3 plus Bronchi-Shield III)

Date of Last Worming:

Heartworm Prevention:

Yes No (if yes, please specify brand ...)

Is Your Pet Insured?:

Yes No

Insurance Provider

Policy Number:

Check this box to register additional pets.

Additional Pet

Pet Name:

Cat/Dog/Other:

Breed:

Colour:

Sex

Male Female

Desexed

Yes No

Microchip ID:

(This could also be your pets Microchip number)

Date of Birth:

Date of Last Vaccination:

Type of Vaccination:

(Please type in what was on your last vaccination record - e.g. 15 June 2012 Protech C3 plus Bronchi-Shield III)

Date of Last Worming:

Heartworm Prevention:

Yes No (if yes, please specify brand ...)

Is Your Pet Insured?:

Yes No

Insurance Provider

Policy Number:

How did you find out about our clinic?

Website Yellow Pages Newsletter Passing By/Saw Sign Friend/Existing Client Other (Please Specify below)

(If refered by a friend, please type their name and address so that we can thank them in the above field.)

Type the code shown:

The submitted code is incorrect

This information will be sent to your veterinary clinic so they can update your pet’s file and they may also use it to remind you when vaccinations are due, confirm upcoming appointments, advise you about local health alerts and provide information that relates to your pet’s health or clinic promotional offers. A copy of this information will also be received by the website hosting company for data recovery purposes only, if required.

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