New Registration: Individual

  • SHOULD ANY OF YOUR CONTACT DETAILS CHANGE, YOU ARE TO PLEASE INFORM RECEPTION IMMEDIATELY

  • YOUR ACCOUNT REMAINS YOUR RESPONSIBILITY - EVEN IN THE EVENT YOU AGREE TO HELP SOMEONE ELSE USING YOUR ACCOUNT.

Person Responsible for the Account

Alternative Contact Person

Patient(s) Information

Patient 1

Patient 2

Terms and Conditions

  • For the safety of your pet, all owners must be in full control of animals (i.e. on a lead or in a carrier cage).
  • Quotes can be provided on request.
  • This is a cash-based practice. Fees must be paid immediately after consultations or at discharge of the patient. Please discuss costs with veterinarian before admission of the patient(s). 50% deposit MUST BE PAID when your pet is admitted to hospital.
  • Strictly cash transactions: food, merchandise and over-the counter products, consultations, medications, vaccinations, and sterilisations.
  • Services will only be provided to minors if accompanied by written permission from the pet’s owner, along with a copy of the parent/guardian's ID and proof of address. The pet’s owner will be responsible for informing the veterinarian of any previous or current treatments, as well as any professional contact with other veterinary facilities regarding the patient.

Disclosure of Your Personal Data

Confirmation of Consent: Person Responsible for the Account

By submitting this form, I certify that I understand and accept these terms and hereby give permission for services to be rendered. I also hereby indemnify all veterinarians, nurses and staff of this practice against any claim for damages of whatsoever nature that may arise out of procedures and treatments of my pet(s) and/or animals. I accept full responsibility for costs incurred and the full payment thereof.

Thank you for your registration! Your information has been submitted to Wellington Animal Hospital for filing. If you have any questions regarding this application, please feel free to contact us at adminwell@wahg.co.za.
Something went wrong while submitting the form. Please try again, but if the problem persists, please feel free to contact us at adminwell@wahg.co.za for a digital PDF or paper application.