burst-lines-for-top-right-corner-dark-blue-160px-1

New Client Form

Thank you for choosing Kippax Veterinary Hospital for your pet’s care. To help us get to know your pet’s needs, please complete our online New Client Form.

Get Started

New Client Form

Please fill out this form as completely and accurately as possible to help our team get to know you and your pet(s).

Name *

First

Last

Email *

Primary Phone *

Secondary Phone

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Who else is authorised to make decisions about your pet's healthcare? *

First

Last

Phone *

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Speyed Female

Does your pet have a microchip identification? *

What is the microchip number?

Do you have a second pet? *

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Speyed Female

Does your pet have a microchip identification? *

What is the microchip number?

Do you have a third pet? *

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Speyed Female

Does your pet have a microchip identification? *

required. Email should

What is the microchip number?

Do you have a fourth pet? *

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Speyed Female

Does your pet have a microchip identification? *

What is the microchip number?

Do you have a fifth pet? *

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Speyed Female

Does your pet have a microchip identification? *

What is the microchip number?

How did you find out about our hospital? If you were referred by someone, who should we thank? *

We accept cash, debit cards, and credit cards (including Visa and Mastercard). Pet insurance and GapOnly™ claims are also welcome. Payment is required in full at the time of service. For hospital admissions, a signed consent/estimate form and a deposit may be required. *

I have read and accept the financial policy.

Message

Contact Kippax Veterinary Hospital

Questions? Comments? We’re here to answer! Contact us today by completing our online form, and a member of our team will be in touch shortly.



Contact

Phone: 02 6255 1242
Email: info@kippaxvet.com.au



Location

82 Hardwick Crescent
Holt, ACT 2615

(Located next to the McDonald’s)



Hours

Monday – Friday: 7:30 am – 6:30 pm
Saturday: 8:00 am – 12:00 pm
Sunday: Closed