Register Please note your completed form will be processed within 48 hours (two working days). Title* Your first name* Your last name* Address*Postcode* Email address* Mobile number*Additional contact telephone number Please select a practice*SelectFulford Road SurgeryAcomb SurgeryHaxby SurgeryPet name* Pet species and breed* Sex of pet* Male Female Pet Colour Microchip Number (if known) Pet's Date of Birth DD slash MM slash YYYY Last vaccine date DD slash MM slash YYYY Please specify the brand name Is your pet neutered* Yes No Unsure Is your pet insured* Yes No Name of insurance company and policy number (please contact your insurance company to authorise them to discuss your policy details with Tower Vets – failure to do this can result in a delay in claim processing) Previous vets they were registered with Name of additional individual to authorise treatment on your behalf, if required How can we help you? (max 15 words) – a member of our team will be in touch to discuss your requirements once your pet has been registered.*We’d like to update you occasionally with pet health news and offers that we think you’ll be interested to hear about. If you do not wish to receive these, please tick below. I agree to have read and accepted your terms and privacy policy. I am over the age of 18* To help support you in managing the health of your pets we would like to send you appointment and medication reminders and contact you regarding any essential contractual matters. If you do wish to receive these please select the box below:* Yes, please send me appointment and medications reminders No CAPTCHA Submit Enable cookies to show the form. Manage my cookie choices
