Register as a Client - Step 1 of 5Please complete the fields below and a member of our team will be in touch to confirm your registration with the practice. If you have several horses, you can return to this page to register additional horses. Select Branch *AshfordCanterburyHawkhurstRyePlease select your local Branch.Title *MrMrsMissMsDrRevName *FirstLastAddress *Address Line 1Address Line 2CityState / Province / RegionPostal CodePlease fill in your full postcode.Email *Telephone *Mobile *NextAddress (Livery Yard Other)Address Line 1Address Line 2CityState / Province / RegionPostal CodePlease fill in your full postcode.Click Next if not applicablePreviousNextWhere do you keep your horse?Home Address (As Above)Livery Yard (Other)If Livery Other, please provide details below.HORSE'S DETAILSPlease fill in your horse's details below and click Register with Practice, If you have more than one horse you will need to register them all separately.Name *Breed/TypeAge/DOB *ColourApprox HeightSex *GeldingMareStallionMicrochip Details *MicrochippedNot MicrochippedMicrochip NumberPassport DetailsPreviousNextEQUINE HEALTHCARE PLANOur health plan provides regular health & dental checks, vaccinations and worm egg counts. Would you like a member of our team to call you to discuss further? *Yes please call meNo thank youhttps://milbournequine.co.uk/equine-services/equine-healthcare-plan/INSURANCE DETAILSCurrent Insurance Status *InsuredNot InsuredCurrent InsurerPlease specify if applicable. If your equine is currently insured, please specify your current insurer here.How did you hear about us?We would also be very grateful if you could let us know how you heard about our practice.Previous PracticePlease state the name of previous veterinary practice your equine(s) were registered with if applicable.Data Protection: We will use the personal information you give us exclusively for the purposes of registering your pet with Milbourn Equine Vets. We will not pass on any of your details to any outside organisations or individuals unless with your express consent.NextWe require your formal permission to use your email address and/or your mobile telephone number so that we can contact you electronically. This would be to:- let you know when your horse's vaccinations are due, reminders for treatments, Equine Healthcare Plan, to contact you with test results and call backs relating to your horse, insurance form and laboratory form processing or referral to specialists Please tick all the relevant boxes below to confirm your preferences. If you change your mind at anytime about your marketing preferences please contact us. If you do not wish to be contacted electronically please be aware this may result in not receiving notifications regarding your horse's healthcare. Please note all our incoming and outgoing telephone calls are recorded for training and monitoring purposes and deleted after 30 days.Vaccination Reminders *TextEmailPostNoneParasite Reminders *TextEmailPostNoneAppointment/Healthcheck Reminders *TextEmailPostNoneNewsletters *TextEmailPostNoneSurveys *TextEmailPostNoneOffers & Promotions *TextEmailPostNoneGDPR Agreement *I consent to having this website store my submitted information so they can respond to my inquiry.Date *Please date the form = PhoneSubmit
