Add A Pet Form New Leave a reply Step 1 of 3 - You and Your Pet0%First Name*Surname*Email* We will send your policy documents to this addressNew Pet Name*Date of Birth* Date Format: DD slash MM slash YYYY Pets younger than 6 weeks old cannot be added to your cover. We will request a complete vet history for all dogs between 8 & 9 years joining Option 1 & 2, and all cats 9 years & older joining Option 1 & 2. All dogs 9 years and older are offered our Accident Cover only on joining.Cat or Dog*DogCatBreed of Dog*CrossbreedOtherAffenpinscherAfghan houndAiredale terrierAkitaAlaskan MalamuteAmerican Staffordshire terrierAmerican water spanielAustralian cattle dogAustralian shepherdAustralian terrierBasenjiBasset houndBeagleBearded collieBedlington terrierBernese mountain dogBichon friseBlack and tan coonhoundBloodhoundBorder collieBorder terrierBorzoiBoston terrierBouvier des FlandresBoxerBriardBrittanyBrussels griffonBull terrierBulldogBullmastiffCairn terrierCanaan dogChesapeake Bay retrieverChihuahuaChinese crestedChinese shar-peiChow chowClumber spanielCocker spanielCollieCurly-coated retrieverDachshundDalmatianDoberman pinscherEnglish cocker spanielEnglish setterEnglish springer spanielEnglish toy spanielEskimo dogFinnish spitzFlat-coated retrieverFox terrierFoxhoundFrench bulldogGerman shepherdGerman shorthaired pointerGerman wirehaired pointerGolden retrieverGordon setterGreat DaneGreyhoundIrish setterIrish water spanielIrish wolfhoundJack Russell terrierJapanese spanielKeeshondKerry blue terrierKomondorKuvaszLabrador retrieverLakeland terrierLhasa apsoMalteseManchester terrierMastiffMexican hairlessNewfoundlandNorwegian elkhoundNorwich terrierOtterhoundPapillonPekingesePointerPomeranianPoodlePugPuliRhodesian ridgebackRottweilerSaint BernardSalukiSamoyedSchipperkeSchnauzerScottish deerhoundScottish terrierSealyham terrierShetland sheepdogShih tzuSiberian huskySilky terrierSkye terrierStaffordshire bull terrierSoft-coated wheaten terrierSussex spanielSpitzTibetan terrierVizslaWeimaranerWelsh terrierWest Highland white terrierWhippetYorkshire terrierBreed of Cat*OtherAbyssinianAegean catAustralian MistAmerican PolydactylAmerican BobtailAmerican CurlAmerican LonghairAmerican ShorthairAmerican WirehairAsian Semi-longhairBalineseBengalBirmanBombayBrazilian ShorthairBritish ShorthairBritish LonghairBurmeseBurmillaCalifornia Spangled CatChantilly/TiffanyChartreuxChausieCheetohColorpoint ShorthairCornish RexCymricDevon RexDonskoy or Don SphynxDragon LiEgyptian MauEuropean ShorthairExotic ShorthairGerman RexHavana BrownHimalayan/Colorpoint PersianJapanese BobtailJavaneseKoratKurilian BobtailLaPermMaine CoonManxMunchkinNebelungNorwegian Forest CatOcicatOjos AzulesOregon RexOriental BicolourOriental ShorthairOriental LonghairPersianPeterbaldPixie-bobRagamuffinRagdollRussian BlueRussian White, Black and TabbySavannahScottish FoldSelkirk RexSerengeti catSiameseSiberianSingapuraSnowshoeSokokeSomaliSphynxSumxuThai/Old-style SiameseTonkineseToygerTurkish AngoraTurkish VanTurkish VankedisiTwisty Cat/SquittenUkrainian LevkoyUssuriYork Chocolate CatGender*MaleFemaleIs your pet sterilised? (Optional)YesNoHas your pet been adopted or rescued within the last 6 months?YesNoPets over the age of 6 months at the time of adoption, and without a complete vet record, are temporarily offered cover limited to R3 000 for the first 6 months after joining. This would not apply in the case of an accident during this period.Policy No:*This is your existing policy number for your current policy with MediPet.Cover option for your pet*Option 1Option 2Accident OnlyOption 1: Classic, day-to-day, affordable cover for illness, accidents & holistic wellness Option 2: Ultimate, worry-free coverage for illness, accidents, dental, prescription foods & holistic wellness Accident Only: Basic, unforeseen accident cover geared towards our golden oldies.Cover option for your pet*Option 1Option 2Accident OnlyOption 1: Classic, day-to-day, affordable cover for illness, accidents & holistic wellness Option 2: Ultimate, worry-free coverage for illness, accidents, dental, prescription foods & holistic wellness Accident Only: Basic, unforeseen accident cover geared towards our golden oldies.Cover option for your pet*Accident OnlyAccident Only: Basic, unforeseen accident cover geared towards our golden oldies.Routine Care Add-On*YesNoRoutine Care Add-On contributes towards vaccinations, any tick/flea, deworming treatments, microchipping and sterilisation. Has your pet ever been to the vet for medical reasons?*YesNoWe do not require routine care visit histories. These include vaccinations, sterilisations, deworming, tick & flea control, and microchipping.Details of Visit Approximate Date of Visit Details of Visit to Vet Has your pet fully recovered from this event? EditDelete There are no Entries. Add Entry Does your pet take any medication?*YesNoInclude any supplements and naturopathic/homeopathic substances.Add information regarding Medication Details of and reason for medication? Has your pet fully recovered from the condition requiring medication? EditDelete There are no Entries. Add Entry Eye/Ear Conditions*YesNoAdd information regarding Eye/Ear Conditions Date Description of condition Has your pet since fully recovered? EditDelete There are no Entries. Add Entry Lameness?*YesNoAdd information regarding Lameness Date Description of condition Has your pet since fully recovered? EditDelete There are no Entries. Add Entry Vomiting/Diarrhoea?*YesNoAdd information regarding Vomiting/Diarrhoea Date of visit? Has your pet fully recovered? EditDelete There are no Entries. Add Entry Skin irritations or conditions?*YesNoAdd information regarding Skin Conditions Date Description of condition Has your pet since fully recovered? EditDelete There are no Entries. Add Entry Any other diagnosed or treated conditions?*YesNoAdd information regarding any other diagnosed or treated conditions Date Description of condition Has your pet since fully recovered? EditDelete There are no Entries. Add Entry Vet Contact Vet Clinic or Hospital Phone Number EditDelete There are no Entries. Add Entry Disclaimer* I accept that non-disclosure of any previous condition(s) may result in the cover being voided with immediate effect Please keep in touch with me. We won't send you anything unless we have something important to say.CommentsThis field is for validation purposes and should be left unchanged. 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