Register as a client

If you would like to register as a client, please call 01428 723594 or fill in and submit the following form. If you are an existing client and would like to register a new horse or donkey with us please call 01428 723594.

Register with us

"*" indicates required fields

This field is for validation purposes and should be left unchanged.

Title*

Forename(s)*

Surname*

Date of Birth

MM slash DD slash YYYY

Address line 1*

Address line 2*

Town/City*

Postcode*

Home Telephone

Work Telephone

Yard Telephone

Mobile Telephone

Email address

If you have lived at your current address for less than 3 years, please supply details of any previous addresses in the last 3 years.

How did you hear about us?*

Horse / Donkey Details

Full Name*

Stable Name

Passport number

Microchip number

Year of Birth

Sex

S = Stallion G = Gelding M = Mare

Breed/type

Colour

Approx. height

If you have more than one horse please click here.*

Yes

Second Horse

Full Name*

Stable Name

Passport number

Microchip number

Year of Birth

Sex

S = Stallion G = Gelding M = Mare

Breed/type

Colour

Approx. height

Third Horse

Full Name*

Stable Name

Passport number

Microchip number

Year of Birth

Sex

S = Stallion G = Gelding M = Mare

Breed/type

Colour

Approx. height

Address at which horse(s) is/are kept

To ensure that we can provide optimal 24 hour emergency cover to our clients horses we regret that we cannot register clients with horses that are kept outside of our catchment area.

Address line 1*

Address line 2*

Town/City*

Post code*

Telephone

Direction Details

Further Information

Previous veterinary practice

I hereby request to be registered as a First Opinion client of the Liphook Equine Hospital.

Consent & Privacy Notice for new clients

Consent & Privacy Notice for new clients We respect your privacy and are committed to protecting your personal data.

Consent & Privacy Notice for new clients

We collect and use your personal data for a number of reasons, such as for our legitimate interests (or those of a third party) where your interests and fundamental rights do not override those interests. The welfare of your horse is our priority. That’s why we will use your personal details to let you know when your horse is due vaccinations. We may also send you appointment and health check reminders, Practice/horse care advice, and we may ask you to fill out reviews and surveys. We will collect your personal data when we are about to enter or have entered into a contract for delivering veterinary services to you. This may include sending your contact details and the clinical history of your horse along to referral services for further treatment of your horse, but we will let you know if this is necessary. We may collect and use your personal data where we need to comply with a legal or regulatory obligation. We may use your Identity, Contact, Technical, Usage and Profile Data to form a view on what we think you may want or need for your horse(s), or what may be of interest to you. If you consent for us to do so, we will use this information to send you marketing messages about products, services, and offers that may be of interest to you. You have the right to withdraw consent at any time.

Your legal rights

Under the General Data Protection Regulations (GDPR), you can request access to and rectification or erasure of your data. You may object to or request restriction of the processing of your data, and you have a right to data portability. If you wish to exercise any of these rights, please contact the Data Protection Compliance Officer at the below address.

Communication Consent

We would like to communicate with you about the practice and its activities. To do so we need your consent. Please fill in your name and address and other contact information below and confirm your consent by ticking the boxes.

Contact details

Our full details are: Liphook Equine Hospital Limited (registered in England and Wales under company number 10465731), Spitfire House, Aviator Ct, York YO30 4UZ

Data Protection Compliance Officer

VetPartners Limited, Spitfire House, Aviator Court, Amy Johnson Way, York YO30 4GT dataprotection@vetpartners.co.uk

I am happy for you to contact me for the following:

Information about the practice, such as new changes to opening hours and introducing new members of the team

Information about new services and products and promotional offers which may be of interest to me

I would like to receive communications:

by email

by phone (including text message)

by post

Confirm age*

I am over 18 years of age

Confirm terms of business*

I agree to be personally responsible for the payment of all reasonable fees and agree to abide by the practices Terms of Business. Payment is required in full within 10 days of invoice for all First Opinion clients.

Confirm credit check*

I agree that the practice may carry out a credit check with a regulated credit agency and may contact my previous veterinary practice, if required, both to obtain medical histories and to confirm that I/we do not have any outstanding accounts.

Clinical history consent*

I consent to the practice obtaining my horse’s clinical history, which may include my own data, from previous practices.

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