Dauphin Vet Clinic

1801 Main Street South, Dauphin MB

Monday to Friday 8:30am - 5:00pm

(204) 638-3044

Ste Rose Vet Clinic

15 Tucker Street, Ste Rose du Lac MB

Monday to Friday 9:00am - 5:00pm

(204) 447-2701

Please complete the following form to the best of your ability and return it to us 24 hours before your pet’s scheduled appointment.

Owner's First Name

Last Name

Address

City

Province

Postal Code

Email

Patient's Name

Appointment Date

Primary Phone Number (s)

Will you be reachable at this number on procedure day?

Yes

No

Phone number(s) I can be reached: