New Client Form

Save time at your first appointment. Complete your new client form online before your visit.

New Client Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

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Pet Owner Primary Contact Information

Please Indicate Primary Contact
Secondary Pet Owner
How would you like to receive your pet's health reminders?
Do you have Pet Insurance?
May we contact your current or previous veterinarian for medical records?
How did you hear about us?

New Patient Pet Registration

Number of Pets

Payment Information

Please be aware that payment is due at the time of services. For your convenience, Eastern Animal Hospital accepts multiple types of payments. However, we do not offer billing and we do not accept personal checks. Please understand that payment is due at the time that services are rendered and a deposit will be required upon admission of your pet to the hospital for treatment. The balance will be due when your pet is discharged.

Your Method of Payment Will Be

Photo and Information Release

Eastern Animal Hospital takes photographs for business purposes. I authorize and give full consent to Eastern Animal Hospital, it's representative, employees and assigns to take photographs of my pet and/or me and to copyright, use and publish the same in print and/or electronically (including Facebook and other social media forums). I further grant full permission to Eastern Animal Hospital, it's representatives, employees and assigns to use, or caused to be used, these photographs and/or either my name and/or my pet's name (if necessary) for any purpose (such as but not limited to advertising, marketing, publications, electronic distribution and the internet) without limitations or reservations whatsoever. This consent also serves to waive all rights of privacy or compensation which I may have in connection with the use of any photograph in which either my pet or I appear.

I Authorize and Give Consent to the Above