Metrowest Veterinary Associates, Inc.

207 East Main Street
Milford, MA 01757

(508)478-7300

mvavet.com

New Client Registration

If you would like to register as a new client, you can assist us by submitting this form.  To be called to schedule an appointment, please check the appropriate box on the form.  Otherwise, call us at 508-478-7300 when you need to schedule a visit for your pet.

Thank you for your cooperation in letting us assist you.   
                      
                                                                                           
Hospital               Clinic
 
                                                                                                                            Policies               Hours

New Client

Name & Email (required)
First Name (required)
Last Name (required)
Address (required)
Street Address (required)
City (required)
,
State / Province (required)
Zip / Postal Code (required)
Phone #1 (indicate Home/Work/Cell) (required)
Phone TypePhone Number (required)
Phone #2 (indicate Home/Work/Cell)
Phone TypePhone Number
Phone #3 (indicate Home/Work/Cell)
Phone TypePhone Number
E-Mail Address :
Alternate Contact(s) / Name / Home phone / Work phone

Pet's Name (required)

Age: Years, Months

Type of Pet (required) :
Breed:

Sex: (required)
Male
Female
Not sure


Has pet been Neutered/Spayed?
Neutered
Spayed
Not sure


Are your pets vaccines current?
Yes
No
I don't know


Do you have pets medical records?
(Please bring records with you to your appoointment if you have them)
Yes
No


Medical records at another veterinary Practice?
Yes
No


Name of Former Veterinary Practice

May we request a transfer of records?
Yes
No


Check here if you would like us to call you to schedule an appointment.
Check here if you are a previous client of Metrowest Veterinary Associates, Inc.
Special requests or conditions?

Please list any additional pets here

Please Read
I understand, by indicating I agree and submitting this registration, that I am responsible for any charges incurred by my pet while in the care of the doctors at Metrowest Veterinary Associates, Inc. and that charges are due and payable at the time of service, unless other arrangements are made in advance. Any balance that is carried over a period of 30 days may accrue a monthly finance charge of 1.5% or 18% per annum. Any balance that I leave unpaid may be forwarded to Metrowest Veterinary Associates, Inc.'s collection agency, and will incur a $25.00 collection fee for which I am liable, in addition to monthly finance charges.
I have read this statement and -
I Agree
I Disagree



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