New Client Form

Rustic Line

Welcome, New Clients!

New Client Form

Welcome! If you would like to make an appointment, you can assist us to expedite your check in by submitting this form.


"*" indicates required fields

Pet Owner Information

MM slash DD slash YYYY

Employment Information

Spouse/Other's Information


In case of EMERGENCY, is there anyone else we can contact if you / your spouse / other are unavailable?

Patient Information

I hereby acknowledge that Clinton Animal Hospital DOES NOT BILL for services. Payment is expected at time services are rendered. We accept Cash, Personal Check with driver’s license, American Express, Visa, Mastercard, Discover, and Care Credit. $25.00 charge for NSF checks. A deposit may be required for hospitalized pets.
Owner Signature*
This field is for validation purposes and should be left unchanged.