New Clients Request an Appointment

This form should only be used for requesting appointments that will take place at least 2 full business days after the time of the submission of this form.​​​​​​​ Please provide the information below as completely as possible. All information is strictly confidential.

CLIENT INFORMATION

* indicates a required field

PET INFORMATION

Type of Pet
Spayed / Neutered?
Are Vaccinations Current?
Do you have pets medical records?
Medical records at another veterinary Practice?
Would you like us to call you for your appointment
Reasons or conditions that prompted your visit?
Special requests or conditions?
Please list any additional pets here

REQUEST AN APPOINTMENT

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 Pittsfield Veterinary Hospital 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 will accrue a monthly finance charge of 1.5% or 18% per annum. Any balance that I leave unpaid will be forwarded to Pittsfield Veterinary Hospital's collection agency and will incur a 25% collection fee for which I am liable, in addition to monthly finance charges.

Confirmation *