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Our Services
veterinary care
Ambulatory Services
Complementary Treatments
Cutting Edge Therapies
Dentistry
Diagnostic Imaging
Emergency Services
Hospitalization
Lameness & Pre-Purchase Exams
Magnetic Resonance Imaging (MRI)
Sports Medicine
Surgery
Our Facilities
top tier equine care
Our Doctors
board certified
Dr. Dennis Rach
Dr. Greg Evans
Dr. Shawn Mattson
Dr. Chris Berezowski
Dr. Mike Scott
Dr. Jennifer Fowlie
Dr. Erin Thompson
Dr. Matthew Malyk
Dr. Jordan Cook
Dr. Shannon Lockhart
Dr. Katherine McDonald
Dr. Erin Clarke
Dr. Gillian Haanen
Dr. Holly Sparks
Dr. Ashley Whitehead
Dr. Renaud Léguillette
Dr. Gord Davis
Our People
the difference
Current Job Opportunities
Intern/Extern
Technician Team
Support Team
Contact Us
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Online Forms
referral & new client forms
New Client Registration Form
Scintigraphy Referral Form
MRI Referral Form
New Client Registration Form
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New Client Registration Form
If you are a human and are seeing this field, please leave it blank.
Fields marked with
*
are required
Client Information
Title
*
Dr.
Mr.
Mrs.
Ms.
Miss.
First Name
*
Last Name
*
Home Phone
*
Cell Phone
Work Phone
Apartment/Unit
Address
*
City
*
Province/State
*
Postal/Zip Code
*
Email Address
*
Help Moore Equine Veterinary Centre Ltd. go "Green". Can we send your statements and invoices to you via email?
*
Yes
No
If Horse Is Insured Please Fill In Insurance Information
(If your horse is insured, please be sure to inform your veterinarian)
Insurance Company
Contact Number
Emergency Contact
(not living at same address)
Name of Local Friend Or Relative
Relationship To Client
Home Phone
Cell Phone
Preferred Method of Payment
*
Cash/Debit
Cheque
Online Banking
Credit Card
Trainer Information
Trainer's Name
Trainer's Phone
I agree that my trainer, as listed above, is authorized to have Moore Equine Veterinary Center Ltd. provide veterinary care for the horse(s) listed below up to $___ per horse.
(please specify amount below)
Boarding Location
Stable Name
Patient Information
Name
Breed/Color
Date Of Birth
Gender
Select
Stallion
Mare
Gelding
Discipline
Name
Breed/Color
Date of Birth
Gender
Select
Stallion
Mare
Gelding
Discipline
Name
Breed/Color
Date Of Birth
Gender
Select
Stallion
Mare
Gelding
Discipline
Name
Breed/Color
Date Of Birth
Gender
Select
Stallion
Mare
Gelding
Discipline
Customer Consent
I agree to pay in full for all veterinary services upon treatment or admission of my animal to the hospital. Should I default on any such payments, I, the undersigned, agree to pay 18% interest per annum, and if further action is required, a 30% Collections Fee, any reasonable attorney fees and any court costs incurred. I agree that by submitting this application, I am electronically signing the application. I, the undersigned, solemnly declare that the information I have provided is true to the best of my knowledge.
Full Name
*
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