Hamlin Animal Hospital - Make An Appointment

Client Information

New Client or Old Client

New Client

Existing Client

Were you referred to us by another veterinarian, or do you currently have a primary veterinarian?

Previous Veterinarian Name & Phone

Previous Veterinarian Name

Primary Veterinarian Phone Number

Please send your pet’s records to this email: contact@hamlinvet.com

Your Name(Required)

First Last

Spouse or Partner’s Name

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Spouse or Partner’s Phone

Email(Required)

Pet Information

Pet's Name(Required)

Age/DOB(Required)

Color

Breed(Required)

Species

Canine

Feline

Other

Sex(Required)

Male

Male – Neutered

Female

Female – Spayed

Up to date on vaccines?

Yes

No

Previous Veterinary Clinic

Appointment Details

What is the appointment for?(Required)

If this is an emergency, or your pet is in pain or injured, or you need an appointment today please call our office.

1st Choice Appointment Date(Required)

Time(Required)

Morning

Midday

Evening

2nd Choice Appointment Date(Required)

Time(Required)

Morning

Midday

Evening

Appointment Reason(Required)

How Did you Hear About Us?

Consent(Required)

I certify that I am the legal owner/agent of the above-mentioned pet and I hereby authorize Hamlin Animal Hospital to examine, prescribe for, and/or treat the above-described pet(s). I assume financial responsibility for all charges incurred in the care of this animal. I also understand that these charges will be paid at the time of release and that a deposit may be required for treatment.

Signature

Your Name
Your Name
Your Name

Date

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