New Client Form

Name: Kittery Animal Hospital
Address: 195 State Rd., Kittery, ME, 03904, United States
Telephone: 207-439-4158
Price range: $

Please fill out this form as completely and accurately as possible.

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. If this is an emergency, or if your pet needs urgent care, please call us at 207-439-4158 for a faster response.

Owner's Name *

First

Last

Email *

Any authorized guardians:

Are you the legal owner(s) of the Animal(s) *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Primary Phone *

Secondary Phone

Would you like text reminders?

Email - Your email can be used to view your pet's medical records, make appointments, refill prescriptions, and more! *

Would you like email reminders?

Date of Birth *

Driver's License Number - Required for Prescriptions *

Please specify the animal(s) you are interested in adopting: *

Pet Information

Pet Name *

Species *

Dog
Cat
Other

Breed *

Color markings *

Date of birth or age *

Sex *

Male
Female

Spay or neutered? *

Has a microchip? *

Name of previous vet? *

Please remember to have your previous Veterinarian forward medical records to info@kitteryanimalhospital.com *

I have read and understand

Add a second pet? *

I grant Kittery Animal Hospital and Creature Comforts permission to post my pet’s picture and story on social media. *

Yes!
No, thank you

We will gladly prepare a written estimate if you desire (please ask your technician or doctor). This will be important to you since ALL SERVICES ARE DUE THE TIME SERVICES ARE RENDERED.

We accept Cash, Check, Visa, MasterCard, Discover, Scratchpay, or Care Credit Card.

Signature *

Clear Signature

By signing this document you agree to accepting all financial responsibility for any and all treatments performed, and that you are at least 18 years of age or older.

Date *

New Client Form

New Client Form

Pet Information

connect with us via the PetDesk app!

Contact Us

Address

Contact

Hours

Questions?