New Client Form | Town & Country Vet in St. Lawrence County, NY

Welcome, New Clients!

We know your pet’s health is important and we thank you for trusting us to care for them.

To help us provide the best care possible, please take a few moments to fill out this form completely. Thank you for your cooperation in letting us assist you.

"*" indicates required fields

Select a Location*

Town & Country Veterinary Clinic Potsdam is not accepting new clients at this time.

Please complete our new client form and a member of our team will be in touch about scheduling an appointment at one of our other locations.

Pet Owner Information

Owner:**

First* Middle* Last*

Address:**

Street* City* State* Zip Code*

Telephone:*

Cell**

Home

Work

Employment:

Employer

Your Title

Address

Email Address

Spouse:

First Middle Last

Telephone:

Cell

Home

Work

Patient Information

Pet's Name

Breed

Color

Sex

Age

Spayed/Neutered?

Allergic Reactions

List dates boosters were last given:

Is your pet currently on a special diet or medication?

Is your pet on Heartworm prevention(What Kind)?

Is your pet on Flea prevention(What Kind)?

Is your pet on Tick prevention(What Kind)?

What food does your pet eat?

List all previous problems that we should know about:

How did you hear about us?

checkbox

GOOGLE

YELP!

FACEBOOK

OTHER

CAPTCHA

Comments

This field is for validation purposes and should be left unchanged.