New Client Form

We are happy to welcome new clients and patients to Midshore Veterinary Service for outstanding, affordable care ranging from wellness and vaccinations to specialty surgery. Before you reach out to request an appointment, please complete our New Client Form. This form provides our team with essential information about you and your pet.

New Client Form
Pet Owner's Name
Pet Owner's Name
First Name
Last Name
Spouse/Other Name
Spouse/Other Name
First Name
Last Name
Address
Address
City
State/Province
Zip/Postal
How Did You Hear About Us?
Species
Please Indicate If Your Pet Is...
Is Your Pet Up to Date on Vaccines?
Is Your Pet on Any Medications?
Do You Have Pet Insurance?

PAYMENT POLICY: All fees are due at the time services are rendered. We Accept cash, checks, all major credit cards and offer Care Credit for surgical and extensive medical services. A deposit of 50% of initial estimate is required when an animal is admitted for medical/surgical services. The remainder of your payment is due upon discharge of your pet.

My signature indicates that I understand that I am responsible for all fees incurred in treating my pet. I hereby authorize the veterinarian to examine, prescribe for or treat my pet, and to have my pet's photo displayed on the clinic's website and/or Facebook. I agree to pay for the reasonable costs of collection, attorney fees & court costs in the even that collection efforts become necessary.