Northdale Veterinary Practice - 48 Victoria Road, Worthing, West Sussex BN11 1XE
Home PageRegister Your PetOur PracticeFind UsNewsOnline Community

Worthing
48 Victoria Road West Sussex BN11 1XE Tel: (01903) 202474

Register Your Pet

Fill in our new client pet registration form.

When you register online, you may choose to have a free health check for your pet with the nurse.  Please indicate on the registration form if you would like to do this and one of our staff will telephone you.

Further offers coming soon.


Please fill in the form below and click submit for it to be sent to us via email. Fields marked with an asterisk (*) are required fields.

How many pets do you wish to register? *

Title: *

Name: *

Surname: *

Address: *

Postcode: *

Home tel no: *

Work tel no:

Mobile tel no:

What is your e-mail address?



Pet's name: *

Pet's D.O.B. / approx age: *

Species (dog / cat / rabbit etc): *

Breed: *

Colour: *


Sex: *
Male Female

Spayed / Castrated: *
Yes No

Insurance company:


Microchip: *
Yes No

ID chip no:



Previous Vet's name:

Previous Vet's phone number:

If your pet was registered under a previous address, please supply this address:


Please confirm that you are happy for us to contact your previous practice in order to obtain your pets records.

Yes, you have my permission to contact my previous practice

Where did you hear about us?


What has prompted registration with us?

Recommendation Location Website

Would you like someone to contact you regarding a free nurse health check for your pets?

Yes No

If so, what is the best time for someone to contact you and on which number?