This form can be used to register either yourself as a client or any new pets that you may have, or alternatively please contact the Practice on 01536 485543 where we would be delighted to register you and your pets.

If you are registered and there are changes to your personal circumstances including changes to your pets then click here.

• * Required fields.

• * Practice: Please select your practice Kettering Hospital Corby Surgery Raunds Surgery Rushden Surgery    Find your nearest practice
• * Title: Title Mr Mrs Miss Dr Prof
• * First Name:
• * Last Name:
• * Address:
•  
• * Town/City:
• * County:
• * Postcode:
• * Home Number:
• Mobile Number:
• * Email Address:

• 
  If you have more then one pet, please only register one intially. We will be in touh with you by phone to confirm your registration. We can register your other pets at this point or when you first visit the practice.
  

• * Pet's Name:
• * Species: Species Dog Cat Bird Chinchilla Chipmunk Ferret Gerbil Guinea Pig Hamster Mouse Rabbit Rat Other
• Species (if other please specify):
• Breed:
• Colour:
• Sex: Sex Male Male Neutered Female Female Neutered Unknown
• Age: - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30+   Year(s)       - 1 2 3 4 5 6 7 8 9 10 11   Month(s)
• Ongoing illnesses and/or        medication?
• Date of last vaccination: Month January Feburary March April May June July August September October November December          Year 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
• * Has your pet been microchipped? Yes
  No
  Not Sure
• * Has your pet been insured? Yes
  No
• Name of insurance company:
• * Is your pet currently registered with another vet? Yes
  No
• If your pet is registered with another vet please state the name of the practice:
  
  
• How did you hear about us? (Please include search engine used if you used the internet)

Please ensure your details are correct and your registration is detailed enough for us to successfully register your pet. Then click the Send button to send us your application.

Privacy:
Northlands Vets will use the personal information you give us exclusively for the purposes of caring for your pet and providing you with information related to care of your pet where this has been requested. We will NOT pass on any of your details to outside organisations or individuals without your prior consent.