New Client / New Patient Form

Welcome to Bristol County Veterinary Hospital, we can’t wait to see you! Please complete the form below so we can get to know you and your pet before your visit.

Client Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone

Cell Phone

Email *

Would you like to receive email reminders, newsletters or notifications? *

Yes
No

Place of Employment

Work Phone

Co-Owner/Co-Agent Name

Co-Owner/Co-Agent Phone

Emergency Contact Name *

Emergency Contact Phone *

Previous Clinic Information

May we contact your previous veterinarian for copies of medical records? *

Yes
No

If not please upload a copy.

Clinic/Veterinarian

Location

Previous Clinic Phone

Pet Information

Pet's Name *

Species

Breed

Sex

Male
Female

Spayed/Neutered?

Yes
No
Not Sure

Color

Age/DOB

Pet Insurance*

If your pet is covered under a veterinary insurance policy, please list the company name and policy number:

Insurance Co

Policy No.

*If your pet is not covered by pet insurance, please note that we here at Bristol County Veterinary Hospital highly recommend it. Please ask us about the different plans out there and what we consider to be the top three.

* All fees are due at the time services are rendered * We accept Visa, MasterCard, Discover, and Care Credit credit cards as well as cash and personal checks with proper identification. *

I have read and understand.

I certify that I am the owner, responsible agent for, or authorized agent of this animal. Decisions regarding the care of my pet shall be made only by me or the coowner/co-agent listed above. Information regarding the care of my pet shall only be released to me or the co-owner/co-agent listed above unless I give written consent to BCVH. *

I have read and understand.

I understand that I am financially responsible for any services or products provided and that payment is due in full at the time services are rendered for today's visit along with all future visits. *

I have read and understand.

Signature *

Date *

Message

Providing compassion, care, and kindness to pets and their people.

ADDRESS

288 Fall River Ave
Seekonk, MA 02771
Click here for directions.

TEMPORARY HOURS

Mon: 8:00 am - 6:00 pm
Tues: 8:00 am - 7:00 pm
Wed: 8:00 am - 6:00 pm
Thurs: 8:00 am - 7:00 pm
Fri: 8:00 am - 6:00 pm
Sat: 8:00 am - 2:00 pm
Sun: Closed

Monday - Friday our phones will be turned off from 1:30 - 2:00 pm for staff lunches.

CONTACT

Phone: 508-336-3381
Fax: 508-336-4528
Email: [email protected]

New Client / New Patient Form

Welcome to Bristol County Veterinary Hospital, we can’t wait to see you! Please complete the form below so we can get to know you and your pet before your visit.

Previous Clinic Information

Pet Information

Pet Insurance*

ADDRESS

TEMPORARY HOURS

CONTACT

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