Registration

Deutsch

Dear Pet Owners,

You can register as a client of the Wagner Veterinary Practice in Berlin using this form.

Even if you have previously been a patient at Dr. Vogel's practice, we kindly ask you to register as a new client. This will allow you to sign the treatment agreement and data protection information online in advance.

Thank you for your trust!

Sincerely,

Henrik Wagner

Client

Fields marked with * are mandatory. All other fields are optional and do not need to be filled in.

I am a corporate client / association / farmer.

Company / Association*

Viehverkehrsverordnung no. (HIT no.)

Disease fund no.

Mrs* Mr* Mx*

Dr. Prof. Dr.

First name*

Surname*

Street*

House no.*

Postal code*

City*

E-mail address*

Date of birth (DD.MM.YYYY)

I would like to enter an additional address.

Street

House no.

Postal code

City

Please enter your telephone and mobile number separately with the country code (+49 for Germany) and the phone number.

Phone no.

Mobile no.*

I want to receive invoices via e-mail.

Special notes:

Patient

Fields marked with * are mandatory. All other fields are optional and do not need to be filled in.

I would like to create a livestock.

Patient name*

Breed

Cross-breed

Livestock no.

Livestock size

Date of birth (DD.MM.YYYY)*

Colour

Weight [kg]

Transponder no.

Passport no.

If an animal is not intended for food production, certain medicinal products may be used in its treatment that are not approved for food-producing animals. This broadens the therapeutic spectrum and allows for additional, medically appropriate treatment options to be used.

No food-providing animal Food-providing animal

By signing this declaration, I confirm that my rabbit is not intended for food production and will not be used for food production by me. I am aware that using the rabbit for the production of food constitutes a violation of the Food and Consumer Goods Act and may be prosecuted as a criminal offense.
(Based on the letter of the Federal Ministry of Health dated 17 February 1995 (Ref. No. 425-7210) regarding the animal owner’s declaration for horses.)
In the event that the rabbit is sold or transferred, I undertake to inform the new owner of this declaration, in particular of the fact that, for medicinal and food-law reasons, the rabbit may not be used for food production.
This declaration is valid indefinitely.

Long-term medication

add drug

Documents / pictures

upload document / picture

Special notes about this patient:

next add additional patient

GDPR consent / Treatment contract

GDPR consent

For the proper treatment and billing of your animals, the storage of certain personal data is necessary, for which we request your consent below.

As the pet owner, I agree that the veterinary practice may store and use the following data to provide the best possible care:
• my address,
• my contact information (e.g., telephone number, email address),
• data related to the treatment of my animals, and
• curative treatments and medications administered.

I agree that my data may be shared, to the extent necessary, with:
• external laboratories,
• external service providers necessary for billing (e.g., clearinghouses),
• pet registries (e.g., TASSO),
• other veterinary practices in the case of a referral, and
• external service providers for communication purposes with the practice.

Furthermore, data will only be shared with third parties within the legal framework, i.e., only after obtaining my explicit consent.

I agree to receive information from the practice about upcoming vaccinations for my animals and to be kept up-to-date with current information from the practice.

I can request information about the scope of the stored data at any time.

I have been informed that this declaration is voluntary and can be revoked by me at any time. In this case, any data already collected will be deleted.

Treatment contract

I confirm that I am the owner of the animal and therefore authorized to enter into a contract for the performance of necessary treatments and surgeries. I further confirm that I am willing and able to bear the resulting costs. In this context, I declare that I am not currently involved in any legal debt proceedings. If I am not the owner of the animal, I confirm that I am acting on the express instructions of the animal's owner. If no authorization is given, or if the animal's owner denies having such authorization, I hereby confirm that I will bear the costs arising from the treatment. To the extent necessary for diagnosis, I authorize you to obtain services from third parties (laboratory tests, etc.) on my behalf and at my expense.

I hereby confirm the accuracy of my statements and commission you to examine and/or treat my animal, assuring you that I am authorized to do so. I acknowledge that after the examination and/or treatment of my animal, I must pay the treatment costs in cash, by debit card, or by credit card. Follow-up treatments are also subject to this agreement.

By signing below, I agree to the treatment agreement and the data protection consent form provided, within the scope of its intended purpose.

I don't want to receive appointment reminders.
I don't want to receive vaccination reminders.
I was previously a client of the veterinary practice Dr. Peter Vogel and agree that my data from previous visits may be accessed for the further treatment of my animals.

I hereby confirm that I am 18 years of age or older.

Please sign in the following field:

City

Date

If you would like to receive a copy of the GDPR consent and the treatment contract, please enter your e-mail address in the following field:

E-mail address

Spam protection: Please mark the horse and the crab:

complete registration delete signature

GDPR consent Imprint