New Patient Form – Rabbit - Britannia Kingsland Veterinary Clinic

New Patients Are Always Welcome!

Facilitate your appointment by completing the form below.

Owner's Name *

Phone Number *

Email *

Rabbit's Name *

Birthday *

Sex *

Breed *

Acquired from? *

Date Acquired *

Please describe your rabbit's enclosure *

My rabbit spends this much time outside of his/her enclosure per day: *

My rabbit has a litter box in his/her living space: *

If yes, how often does he/she use the litter box?

Brand name of litter used: *

Does he/she eat the litter? *

Which species has your rabbit lived with? *

When my rabbit is around other rabbits, they usually: *

Pleas list the type/brand of those selected above and amount fed per day. *

Does your rabbit get hairball medication? *

When was the last veterinary exam? *

What is the name of the Vet Clinic where the last exam was done? *

Has your rabbit ever had a teeth trim? *

My rabbit has the following health concerns: *

Other helpful information about my rabbit: *

Upload a photo of your animal friend & we'll use it in their patient record.

Allowed file extensions include .png, .gif, .jpg.

Security Question *

I HAVE READ AND UNDERSTOOD THE PRIVACY POLICY *