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  • Step 1
    Clinic information
  • Step 2
    Pet Information
  • Step 3
    Client Information
  • Step 4
    Consent
Step 1 CLINIC INFORMATION

Province
Clinic
Step 2 PET INFORMATION

Pet's Name*
Species*
Pet Breed*
Pet was born*
Gender
Microchip number
Spayed or neutered
Examination Date
Pet's Name*
Species*
Pet Breed*
Pet was born*
Gender
Microchip number
Spayed or neutered
Examination Date
Pet's Name*
Species*
Pet Breed*
Pet was born*
Gender
Microchip number
Spayed or neutered
Examination Date
Pet's Name*
Species*
Pet Breed*
Pet was born*
Gender
Microchip number
Spayed or neutered
Examination Date
Step 3 CLIENT INFORMATION

Salutation
First name*
Last name*
Address line 1*
Address line 2
City*
Province*
Unfortunately, this offer is not available in your region. Please contact us at 1-800-364-8422 to discuss alternative options.
Postal code*
Email*
Phone*
Phone

Email and consent to contact are required for electronic enrollment.
Pet parents without an email address are asked to call 1-800-364-8422 for assistance.

Step 3 SECOND CONTACT (OPTIONAL)

Salutation
First name
Last name
Email
Phone
Phone
By submitting the personal information above on behalf of the named second contact, you confirm you have collected the appropriate and necessary consent authorized under applicable provincial privacy laws and CASL to allow PTZ Insurance Services Ltd. (Pets Plus Us) and its affiliates to contact the second contact regarding their trial of pet insurance and other insurance products or services, special offers and/or news updates offered by Pets Plus Us via email, pre-recorded/automated messages/text messages at the telephone, including mobile number, and email address provided above. You confirm you have made the second contact aware of Pets Plus Us contact information, and the Pets Plus Us Privacy Policy, where their personal data rights are outlined. Second contacts may withdraw their consent and/or update their privacy preferences at any time; instructions for doing so can be found in the Pets Plus Us Privacy Policy.
Step 4 CONSENT

FOR VET STAFF ACTIVATING THIS TRIAL ON BEHALF OF THE NAMED PET OWNER:

Please review the following terms with the named pet owner and confirm with the pet owner you are accepting and agreeing to the following conditions of this agreement on their behalf.

  • The following brief coverage summary is provided by PTZ Insurance Services LTD. Full policy terms and conditions will be delivered to the named pet owner following application submission.
    • A 48-hour waiting period applies for accidents and illnesses. Pre-existing conditions are not covered.
    • Pets Plus Us will reimburse you for 80% of the cost of any covered treatment for conditions arising from an eligible accident(s) or illness(es). You are also responsible for a $100 deductible per incident. Total benefits available under this coverage are $7,500.
    • This coverage is valid for a period of 6 weeks from 12:01 am on the effective date of the trial.
    • Review full policy terms and conditions for all benefits, limitations and exclusions, and contact Pets Plus Us with any coverage questions or concerns.

[PLEASE NOTE: Any questions from the pet owner regarding the above coverage details must be directed to Pets Plus Us. You are prohibited from answering coverage specific questions.]

  • The pet owner must be 18 years of age or older to participate in this offer.
  • The pet owner is only eligible for one (1) Pets Plus Us insurance trial per pet’s lifetime.
  • The pet owner understands and consents to their information being collected and submitted to Pets Plus Us for the purposes outlined in the consent authorization and the Pets Plus Us Privacy Policy, including to process an application for pet insurance, to deliver insurance documents, and to receive email communication relating to special offers and news updates.
  • This form must be completed and received by Pets Plus Us within 48 hours of the pet’s examination date.

*Disclaimer: Insurance policies are underwritten by Northbridge Insurance and administered Insurance Services Ltd. & Société d’Assurances Collectives (Sodaco) Inc. in Quebec. Veterinary clinic staff authorized to use this portal are not insurers and are not engaged in the business of insurance, and do not receive any commission or fees for any customer details submitted to Pets Plus Us for the purpose of providing a trial of insurance.

 
The information herein is summarized. All pet insurance plans have limitations and exclusions. Specific products, features, rates, and discounts may vary by province and territory, eligibility, and are subject to change. Medical Conditions that are noted, symptomatic or diagnosed prior to enrollment, or during a waiting period are pre-existing to Coverage and not eligible for reimbursement. Waiting periods, annual deductible, co-insurance, benefit limits and exclusions may apply. For all terms and conditions visit: https://www.petsplusus.com/service-claims/brochures-guides

© 2023 All rights reserved. Pets Plus Us Pet Insurance policies are underwritten by Northbridge General Insurance Corporation, distributed by PTZ Insurance Services Ltd. & Société d'Assurances Collectives (Sodaco) Inc. in Quebec. Sodaco is registered with Autorité des marches financiers as a Damage insurance broker firm, in the following disciplines: Insurance Damage (Broker) and Personal Insurance (Reg#603622) https://lautorite.qc.ca/en/general-public/registers/register-of-firms-and-individuals-authorized-to-practice Pets Plus Us Pet Insurance is available in all provinces and territories. Pets Plus Us®, Pets Plus Us & Design and related words and logos are trademarks and the property of PTZ Insurance Services Ltd.
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