New Registration Registration Form Personal Details Title * MrMrsMissMsDr First Name * Last Name * Address * Address Address Address City/Town City/Town County County Postcode Postcode Occupation * Home Tel. No. Work Tel. No. Mobile Tel. No. * Email * We like to send our patients reminders for treatments and relevant seasonal items via their owners. Please check all of the methods below that you are happy for us to contact you through. Methods of Contact * Phone Email Text Mail We will never share your personal information with 3rd parties for their marketing purposes. Please see our Privacy Policy for full details. Pet Details Pet Type * Dog Cat Pet Name * Sex * Male Female Unknown Date of Birth * Breed * Colour * Neutered? * Yes No Unknown Microchipped? * Yes No Unknown Microchip ID * Insured With To ensure we are able to provide the best possible care for your pet, it is beneficial for us to keep a record of who your previous Veterinary Surgeon was (please specify details below). Vet Name & Address * plus1 Add Another Pet minus1 Remove This Pet We are interested in understanding how our clients come to us. How did you hear about us? * Our Website Web Search/Google Facebook Twitter Instagram Recommendation (please enter name below) Other (please enter below) Who recommended us to you? (Please enter full name) * How did you hear about us? * BSAVA Position Statement on Stem Cell Therapy The British Small Animal Veterinary Association (BSAVA) recognises that regenerative medicine and stem cell therapy have the potential to provide new treatment strategies for a wide range of diseases and conditions for which there are currently no or limited therapeutic options. Although these treatments have the potential to improve the health and welfare of animals it is important that the benefits and risks are fully evaluated before being made commercially available. The BSAVA supports and encourages scientific research into the development of regenerative therapies including animal stem cell use. The BSAVA recognises the need for well-designed, ethically approved, clinical trials in order to establish a knowledge base on the safety and efficacy of stem cell therapies. The BSAVA recommends that veterinary surgeons considering the use of stem cell therapies should take note of the ethical and evidential issues in recommending any novel treatment. The veterinary surgeon should make clear to the owner the nature of the procedure, the evidence that is and is not available regarding each of the treatment options and ensure that the owner understands that the procedure is “novel”, as part of the process of obtaining informed consent. BSAVA Statement * Yes, I have read and understand the BSAVA position statement above Consent to use of your data * Yes, I have read and agree to the Privacy Policy Terms & Conditions * Yes, I have read and agree to the Terms & Conditions Social Media Consent Yes, I consent to any images taken of my pet to be posted on any social media platform operated by Stem Cell Vet Marketing consent Yes, Stem Cell Vet may send me information regarding special offers, services or products that are relevant to me Signature * signature keyboard Clear reCAPTCHA Submit If you are human, leave this field blank.
