New Patient Registration Form

Thank you for considering our hospital as your pet’s provider of veterinary services. Please complete this form as fully as possible and allow up to 48 hours for your request to be reviewed. Once reviewed you will receive an e-mail.

If you are a client and this is an emergency during business hours, please call us at: (860) 242-5506. If after hours, or if you are not a client, please visit the pet emergencies page to locate an emergency hospital.

IMPORTANT: All new clients must complete this form and submit any prior medical and vaccination records prior to scheduling an appointment at MacDonald Veterinary Hospital.

Owner's Name
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Day-Time Phone*
Email*
Enter Email Confirm Email
Phone
If Personal Referral, is there someone we can thank for this referral?
Pet Information
Pet's Name*
Species*
Breed (if known)
Color
Date of Birth or Age (if known)
Sex
Please use the following box to give us any other relevant information about your pet
Please attach medical records and any additional documentation here (optional)

You will not be able to save the information completed in the form above and it cannot be retrieved. If you need to make a change or add additional documentation after you have submitted the form, please call our office.

Owner's Name

Pet Information

Location:

Contact:

Hours: