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Register With Us
Please complete the form to register your horses with us. You only need to complete this form for horses that we have not seen before.
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* Indicates required question
What is your title?
*
Miss
Mr
Ms
Mrs
Mr & Mrs
Other:
What is your first name?
*
Your answer
What is your surname?
*
Your answer
What is your postal address?
*
Your answer
What is your postcode?
*
Your answer
What is your preferred contact telephone number?
*
Your answer
Please provide any addtional contact telephone numbers that you have:
Your answer
What is your email address?
*
Your answer
Have you read and do you agree to our privacy policy?
*
https://www.millcroftvets.co.uk/content/privacy-policy
Yes
Are you happy for us to send you the following?
Email
Text Message
Post
Vaccination reminders via
Marketing information via
Email
Text Message
Post
Vaccination reminders via
Marketing information via
Which veterinary practice were you previously registered with?
*
We will contact your previous veterinary practice to request the clinical history for your pets.
Your answer
Where are your horses located?
Please provide an What3Words or Google Maps location of where your horse is kept. This enables us to easily find you in the event of an emergency call. Please visit
https://what3words.com/
or
https://maps.google.com/pluscodes/
for help in doing this.
Your answer
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