REGISTRATION FORM

Please return to: Raecleughhead

Duns, Berwickshire, TD11 3NS

Or e-mail to

Tel: 01361 889106

Title: Mr/Mrs/Miss/Other / Yard Owner*:
Owner's Name: / Yard Name:
Address: / Address:
Postcode: / Postcode:
Phone (home): / Phone:
Phone (mobile): / Previous/Current Vet Practice Used:
Email:

*We will assume, unless you advise us otherwise in writing, that any third party giving instructions to us in relation to your horse has your authority to make all decisions of a veterinary nature which are required to be made in relation to your horse and that they are acting in your best interest and as your agent.

Horse 1 / Horse 2 / Horse 3 / Horse 4
Name
Age (yrs) or year of birth
Sex - Mare/Gelding/Stallion
Breed
Colour
Insured for Vet Fees - Y/N
Month Vaccinations Due
Has Section IX of the passport been signed stating the horse is not for human consumption - Y/N

How did you hear about us?: ……………………………………………………………………………..

If it was a friend please mention their name so we can thank them for their recommendation with a free worm egg count.

I am 18 years old or over and am happy for Equitait Veterinary Practice to contact me in relation to my horse(s), my dealings with Equitait or with information about other Equitait services, news or events that Equitait believes may be of interest to me. I have read the privacy policy and understand that Equitait will not pass on my details to any third parties. I consent to Equitait contacting my previous veterinary practice for a copy of my animal’s clinical records. I have read the terms and conditions and agree to be bound by them. For full details of fee and payment terms please refer to our terms and conditions at www.equitait.com/page63.htm

Signed: ……………………………………...... Date: .………………………......

Print Name:……………………………………......

All of our fees are subject to VAT at the prevailing rate. Fee levels are determined by the time spent on a case, together with the cost of drugs, consumables and materials used. Details of our fees are available on request and a detailed invoice is provided for every consultation, procedure or transaction. Whenever possible we will give you an estimate of the cost of treatment, however, variations and complications may arise resulting in further costs being incurred.

'Out of hours' fees are charged when a veterinary surgeon visits out of normal working hours, which are; 8.30am- 5.30pm Monday to Friday. A 'same day emergency' call-out fee will be charged when a veterinary surgeon visits you on the same day as you request the visit.

In order to keep our costs as low as possible and to be able to pass these benefits on to you, Equitait does not offer credit accounts in the vast majority of circumstances. Payment is due at the time of the supply of the goods or services.

If you are not going to be present at the call or will be paying by card now or at a time in the future, please fill in the box below. We will keep your card details securely and will always seek authorisation from you prior to taking payment.

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