NEW CLIENT REGISTRATION FORM Please click here to register New Client Registration Name * First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone number * Email * HORSE DETAILS Full name: * Stable name: * Passport number: Microchip number: Breed: * Colour: * Sex: * Mare Gelding Stallion Colt Filly Date of birth: * MM DD YYYY Age: HORSE LOCATION Horse Location Address: Address 1 Address 2 City State/Province Zip/Postal Code Country Yard owner/manager name: * Yard contact number: HORSE DETAILS (2) Please complete this section for any additional horses. If you only have one horse, please proceed to next section Full name: Stable name: Passport number: Microchip number: Breed: Colour: Sex: Mare Gelding Stallion Colt Filly Date of birth: MM DD YYYY Age: HORSE DETAILS (3) Please complete this section for any additional horses. If you only have one or two horses, please proceed to next section Full name: Stable name: Passport number: Microchip number: Breed: Colour: Sex: Mare Gelding Stallion Colt Filly Date of birth: MM DD YYYY Age: FURTHER INFORMATION Do you give permission for the yard to make an appointment on your behalf? * Yes No Is your horse(s) insured: * Yes No If your horse(s) is insured, who is the provider? How did you hear about us? * Recommendation (please state who below) Search engine (e.g. Google) Word of mouth Social media Advertisement Other Recommendation: COMMUNICATION PREFERENCES Allow vaccination reminders by (please select): * Text / SMS Email Post None Allow appointment reminders by (please select): * Text / SMS Email Post None Allow us to contact you about events we are hosting, seasonal promotions we are offering or to send you guidance on veterinary health or care of your horse (please select): * Text / SMS Email Post None Allow invoice/statement to be sent via email? * Yes No INFORMATION AND DATA Emerson & Watson would like to keep information provided by you on file, for the sole use of the company, directly or indirectly, and will not pass or sell your information onto third party marketing companies. We shall take all reasonable precautions to preserve the integrity and prevent any corruption or loss, damage or destruction of the data and information. When registering as a client to our practice you accept our privacy policy and terms and conditions, which can be found on our website. * I accept the Terms and Conditions Thank you for registering with us. If you would like to book an appointment please call 01344 937937 or email office@emerson-watson.com
