Registration Form Horses

Welcome to Dierenkliniek Den Ham! We kindly ask you to fill in the registration form below completely and truthfully, so that we can provide the best possible care for your horse. The data you enter will be treated confidentially and used according to our privacy policy.

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Owner details

Preamble*

First name*

Surname*

Phone number 1*

Phone number 2

Email address*

VAT number

Adress*

Addition

Postcode*

City*

Country*

Patient details

Chip number*

Name*

Breed

Gender*

Colour

Date of birth*

Passport number*

Patient registration

Whether a horse is suitable or unsuitable for human consumption is determined on the basis of the horse passport, not by the owner. Chapter II (‘Medical treatments’) states whether the horse is suitable for slaughter. If this has not been filled in, the horse is automatically considered suitable for slaughter. Certain medicines result in a permanent ban and therefore make a horse unsuitable.

Registration in passport for human consumption.*

Insurance

Is your horse insured?*

Policy number

Reference

Were you referred by another vet/physiotherapist?*

Name of veterinarian/physiotherapist

Phone number of the referrer

Use on social media

Do you agree that photos/videos of your horse may be posted (anonymised) on the social media or website of Dierenkliniek Den Ham?*

General terms and conditions and privacy policy

Prior to any treatment or procedure, an estimate of the cost may be made. It is possible that the final costs may differ from the estimate. This treatment agreement and all services provided by Dierenkliniek Den Ham BV are subject to the General Terms and Conditions of the KNMvD, which can be found on our website dierenkliniek.nl and via the link below. How we handle your personal data can be found in our privacy policy, also available on our website or via the link below.

Signature*