New Client Registration Form

New Client Registration Form

Thank you for considering our hospital as your pet’s provider of veterinary services. We are dedicated to maintaining the health of your pet and look forward to many future years together.

Please complete this form as fully as possible prior to your first appointment which will help expedite the registration process and give us valuable insight in providing optimal care for your pet(s). The required sections have a red * asterisk.
  • Owner's Name

  • Co-owner's Name & Contact #

  • Address

  • Pet Information

  • Date Format: MM slash DD slash YYYY

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Contact Us

Upper Middle Road Animal Hospital
1450 Headon Rd - Unit 3
Burlington, ON L7M 3Z5

Phone:
905-635-2428


Email:
recepti[email protected]


Doctor is on call for after hours appointments.


Location Hours
Monday12:00pm – 5:00pm
Tuesday12:00pm – 5:00pm
Wednesday12:00pm – 5:00pm
Thursday12:00pm – 5:00pm
Friday12:00pm – 5:00pm
Saturday10:00am – 2:00pm
SundayClosed