Skip to content
Pet Photo Gallery
Helpful Articles
New Client Form
Contact
Call for Appointment
Phone:
(603) 679-4339
| Monday - Friday: 8:30AM - 6PM | Saturday & Sunday: Closed
Hours
Call for Appointment
New Client Form
Client and Contact
First and Last Name
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Cell Phone
Home Phone
Email
*
Add alternate contact?
Yes
No
Alternate Contact Name
*
First
Last
Alternate Contact Phone
Alternate Contact Email
*
How did you become aware of this clinic?
Choose one
*
Hospital Sign
Internet
Another Client
Advertisement
Social Media
Other
If other, please specify
Name of Previous Veterinarian
*
Phone of Previous Veterinarian
Pet Information
Pet 1
Pet 1 Name
*
Sex
*
Male
Male Neutered
Female
Female Spayed
Species
*
Canine
Feline
Breed
*
Color
*
DOB
*
Pet 2 (optional)
Pet 2 Name
Sex
Male
Male Neutered
Female
Female Spayed
Species
Canine
Feline
Breed
Color
DOB
Pet 3 (optional)
Pet 3 Name
Sex
Species
Canine
Feline
Exotic
Avian
Reptile
Breed
Color
DOB
Our Fee Policy
*
I understand that all fees are due at time of service. We accept Cash, Checks, Debit, American Express, Visa, MasterCard, Discover, or Apple Pay. If you are in need of alternative payment arrangements please discuss that prior to completion of services.*
Yes, I understand the fee policy.
Consent
*
I hereby authorize the veterinarian to examine, prescribe for or treat the above described pet(s). I understand that all animals must be current on vaccinations and testing for grooming and hospital procedures. I assume all responsibility for all charges incurred in the care of my animals. I also understand that these charges will be paid for at the time of release and that a deposit may be required for surgical treatments or hospitalization.
Accept
Δ