Registration form | Dierenkliniek Hoogveld

You want to register one or more (domestic) animal(s) at our veterinary clinic. Of course, you and your animal(s) are most welcome! Whenever we examine or treat your animal(s), including the administration of medication, a treatment agreement arises. There are then a number of conditions and rules under which we perform our work. By registering with our practice you declare to agree with these conditions.

Cliënt data

Name

Salutation

Mr.

Mrs.

Family

Other

Initials

Street and house number

City

Postal code

Phone number

Second Phone number

E-mail

My animal may be treated if someone other than myself presents my animal for examination

yes

I would like to receive newsletters/mailings/reminders from the veterinary clinic

yes

In the context of participation in a points savings program, my personal data may/ may not be disclosed to third parties.

yes

I agree to the terms and conditions

By registering with our clinic, you declare that you agree to our terms and conditions.

What do we do with your data?

We collect the data on this page to facilitate you getting in touch with us. We need your data to find you in our customer records.

The data submitted here is emailed to our email address and it is stored in the website's database.

Learn more about your privacy on this website.