New Client Form

Welcome to AMC! Please fill out the form below and click submit to send it to our office. We look forward to meeting you and your pet(s) soon. If you prefer a hard-copy, you can print one here: New Client Form

Owner Details
Co-owner Details (if applicable)
Emergency Contact Details
Patient Details
male female
neutered not neutered
friendly fearful
For Dogs (if the patient is a dog; otherwise, skip)
For Cats (if the patient is a cat; otherwise, skip)
yes no
yes no
yes no
Other details
email physical mail
friend/acquaintance location search engine website other
By clicking submit, I assume responsibility for all charges incurred in the care of this pet. I understand that payment, in the form of Cash, Personal Check, Visa, MasterCard, Discover or American Express, is expected when services are rendered. A signed Health Care Plan will be required for all hospitalized pets.