New Clients

New Client
Form

Ready to start your pet’s care at Clifton Park Veterinary Clinic? We can’t wait to meet you! To begin, please complete our online New Client Form.

Get Started

Welcome to Clifton Park Veterinary Clinic. So we may provide you with the best possible service, please share information about you and your pet(s). Our mission is to provide our clients with top notch health and wellness care.

Please fill out this form as accurately as possible to help us get to know you and your pet(s) before you arrive.

Client Information

Name *

First

Last

Partner/Spouse Name

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone *

Work Phone:

Cell Phone

Email *

Were you referred by a current client?

We require payment when services are rendered. We accept cash, check, Visa, Mastercard, Discover, American Express, and CareCredit for your convenience.

Patient Information

Pet’s Name *

Sex: *

Male
Neutered
Female
Spayed Female

Species: *

Breed *

Color

Pet’s Date of Birth (Month/Date/Year): *

Does your pet have any allergies, special medications or health problems we should know about?

Reason for bringing pet in: *

We request medical records before a patient’s appointment to ensure our providers have a complete medical history and can deliver the best possible care. Records can be sent to our email, cliftonparkvetclinic@gmail.com, or we can reach out to your previous clinic to access records.

Name of Previous Veterinarian:

Previous Veterinarian Phone Number:

By signing below, I verify that all information provided is accurate. *

Clear Signature

Date *

Message

New Clients

New Client
Form

Client Information

We require payment when services are rendered. We accept cash, check, Visa, Mastercard, Discover, American Express, and CareCredit for your convenience.

Patient Information

We request medical records before a patient’s appointment to ensure our providers have a complete medical history and can deliver the best possible care. Records can be sent to our email, cliftonparkvetclinic@gmail.com, or we can reach out to your previous clinic to access records.

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Location

Contact Information

Hours

Independently Owned and Operated