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Telephone:
01706 643617
Wendy Lane Vets
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LITTLEBOROUGH SURGERY
ROCHDALE SURGERY
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HOME
ABOUT US
LITTLEBOROUGH SURGERY
ROCHDALE SURGERY
HEYWOOD SURGERY
OUR STAFF
SERVICES
PRICES
CONTACT US
REGISTER
APPOINTMENTS
PRESCRIPTIONS
REGISTER
Home
REGISTER
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Title
Name
*
First
Last
Address
Postcode
Telephone - Home
Telephone - Mobile
Email
*
Your Pet's Name (Required)
*
Age
Species (eg. cat, dog, rabbit) (Required)
*
Breed
Colour
Sex
*
Male
Female
Neutered
Yes
No
Date of last vaccination
Date of last worming
Microchip number (if applicable)
Insurance company (if applicable)
Name of previous veterinary practice (required)
*
Phone number of previous veterinary practice (required)
*
Do you have any additional pets you wish to register?
*
Yes
No
How did you hear about us?
Former client
Practice signs
Yellow Pages
Local newspaper
Website
Recommendation
Other
If other, then please tell us here:
Would you like us to contact you about a query you have?
Yes
No
If yes, please let us know and how to contact you.
We'd love to send you exclusive offers and the latest information regarding your pet's health by email. We always treat your personal details with the utmost care and will never sell them to other companies for marketing purposes. Do we have your permission to send you offers and services?
Yes please
No thank you
Comment or Message
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