Register as a Client | Milbourn Equine

Please 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 *

Please select your local Branch.

Title *

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Please fill in your full postcode.

Email *

Telephone *

Mobile *

Address (Livery Yard Other)

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Please fill in your full postcode.

Click Next if not applicable

Where do you keep your horse?

Home Address (As Above)
Livery Yard (Other)

If Livery Other, please provide details below.

HORSE'S DETAILS

Please 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/Type

Age/DOB *

Colour

Approx Height

Sex *

Gelding
Mare
Stallion

Microchip Details *

Microchipped
Not Microchipped

Microchip Number

Passport Details

EQUINE HEALTHCARE PLAN

Our 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 our health plan further? *

https://milbournequine.co.uk/equine-services/equine-healthcare-plan/

INSURANCE DETAILS

Current Insurance Status *

Insured
Not Insured

Current Insurer

Please specify if applicable. If your equine is currently insured, please specify your current insurer here.

How did you hear about us? *

Recommendation
Website/Online
Signage
Pegasus Magazine
Other
Prefer not to say

Did a friend recommend you?

Ask them to complete this form and you will both receive a £10 discount subject to T&C's

Previous Practice

Please 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.

We 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 *

Text
Email
Post
None

Parasite Reminders *

Text
Email
Post
None

Appointment/Healthcheck Reminders *

Text
Email
Post
None

Newsletters *

Text
Email
Post
None

Surveys *

Text
Email
Post
None

Offers & Promotions *

Text
Email
Post
None

GDPR Agreement *

I consent to having this website store my submitted information so they can respond to my inquiry.

Your Information. Milbourn Vets is part of Linnaeus Group Limited. We will not share this information with other companies for their marketing purposes. For more details on how we use your information please see our privacy policy. The personal data submitted via this form will be retained only for the purpose of responding to your question or concern, and will not be used for marketing purposes. You must be 16 years old or older to submit a form. We may use your information to send you reminders about products and services you have already purchased from us by SMS, email or post. These may be sent when your pet is due for a vaccination, flea or worming treatment or when your pet is due for a check-up recommended by your vet.

If you would not like to receive these reminders please tick here.

We would like to send you our newsletters and contact you about promotions which may be relevant to you by post, email and SMS. If you agree to being contacted in this way please tick the relevant boxes;

SMS
Email
Post

Date *

Please date the form