Client Information Form

Start

Fill out the form below.

Please Note: All fields marked with * are required. If you have any questions, please feel free to contact us.

Personal Information

Caregiver 1
Caregiver 2

Address Information

Contact Information
**Your email address will be used strictly for internal purposes for communication between Central Veterinary Services and authorized parties. We will email your animal’s appointment notes and reminders, updated policies, internal promotions that would apply to you, as well inclement weather updates, estimates for surgical and medical services, as well as surveys on how to improve or our services.

Emergency Information

I provide my permission to the following individuals (family member, friend, barn manager, etc.) to act as my agent, if necessary, where consent is required for emergency veterinary services for my animal(s) and I am unable to be contacted or I have given prior permission (for example, when travelling).

Emergency Contact 1:

Emergency Contact 2:

Accessibility Information

Statement of Commitment to Accessibility: Central Vet is committed to providing a safe, dignified, and welcoming environment for everyone. We are committed to providing accessible and inclusive services, information, goods and employment opportunities, and facilities wherever possible. Central Vet is committed to meeting the requirements of The Accessibility for Manitobans Act (AMA) and all applicable accessibility and human rights legislation.

We ask that you respond to the following questions to allow us to serve you better and provide the best possible care for our clients and patients.

Payment Terms

At Central Vet we require payment at the time of service or product rendered. Services and products provided off premises may require pre-payment or under specific circumstances may be placed on your account. Payment for these is appreciated upon receipt of your invoice.

We accept payment in the form of cash, debit, e-transfer, and credit card (VISA, MasterCard and American Express). Online banking is also accepted (to pay this way add Central Veterinary Services as a ‘Payee’ and note in the comments your Central Vet account number, which is found after your name on your invoice).

If you would prefer to leave your credit card information with us for automatic processing, please inform our team either in person or by phone. We can add this information to your account and payment would then be processed upon invoice.

*Please note credit card information will be stored in our password-protected clinic software program on computers and a network with up-to-date security protection.

When unexpected illness or injury strikes an animal, unexpected expenses strike as well. We understand this and can assist you with special financing arrangements through the PayBright by Affirm & PetCard programs. It takes just 5 minutes to complete an application and will allow you to break down your payment into monthly installments. Please ask our team or visit our Payment Options webpage for more information.

Privacy of personal information is an important principle to Central Veterinary Services. In compliance with the federal Personal Information Protection and Electronic Documents Act (PIPEDA), we are committed to collecting, using, and disclosing personal information responsibly and only to the extent necessary for the goods and services we provide. The primary purpose for collecting personal information is to provide veterinary services.

Privacy Information

Client Expectations

At Central Veterinary Services, we are on a mission to improve lives. One of the ways we aim to do this is through a focus on providing a safe and supportive workplace – doing everything we can to maintain physical and psychological safety for everyone who interacts with our business. Our core values include kindness & compassion, responsibility, meaningful interactions, inclusivity, and community. We strive to behave in alignment with these values in every interaction. We encourage individuals we work with to provide feedback to help us continuously improve over time. This is what our clients can expect from us.

In turn, we do have expectations of our clients to maintain a healthy working relationship and to protect our team’s mental health and ability to provide a psychologically safe environment for everyone:

  • Respectful communication with us and other individuals visiting the clinic, including verbal, non-verbal or digitally (including on social media)
  • Acting in accordance with our core policies – this includes abiding by our physical and psychological health and safety, accessibility, and inclusivity policies.
  • Refraining from disparaging remarks that could be considered harassment - this includes emotional blackmail, swearing, inappropriate name calling or derogatory remarks or gestures remarks.
  • Adherence to our payment policies.
  • That feedback is given in a respectful, constructive way via the available avenues.

Signature