Registration Form (New)

New Clients – Registration Form

Equitait new client and horse/s registration form. Please fill out the online form below and click submit.

Title

Owners Name *

Owners Address *

Postcode *

Owners Phone Number/s *

Owners Email *

Yard Details

Yard Owners Name *

We will assume, unless you advise us otherwise in writing, that any third party giving instructions to us in relation to your horse has your authority to make all decisions of a veterinary nature which are required to be made in relation to your horse and that they are acting in your best interest and as your agent.

Yard Name

Yard Address *

Yard Postcode *

Yard Phone Number/s

Previous/Current Vet Practice Used

Horse Details

Number of Horses? *

Select the number of horses you wish to register

Form submission

How did you hear about us?

If it was a friend please mention their name so we can thank them for their recommendation with a free worm egg count.

Signature *

I am 18 years old or over and am happy for Equitait Veterinary Practice to contact me in relation to my horse(s), my dealings with Equitait or with information about other Equitait services, news or events that Equitait believes may be of interest to me. I have read the privacy policy and understand that Equitait will not pass on my details to any third parties. I consent to Equitait contacting my previous veterinary practice for a copy of my animal’s clinical records. I have read the terms and conditions and agree to be bound by them. For full details of fee and payment terms please refer to our terms and conditions page.

Date

Email *

Message

New Clients – Registration Form

Yard Details

Horse Details

Horse #1

Horse #2

Horse #3

Horse #4

Horse #5

Horse #6

Horse #7

Horse #8

Horse #9

Horse #10

Form submission