Milton Veterinary Hospital PC

622 Route 29
Middle Grove, NY 12850

(518)587-4676

www.miltonveterinary.com

New Client Check In

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

Thank you for your cooporation in letting us assist you.

New Client

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Phone Type	Phone Number (required)

Evening Phone (required)
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Pet's Name (required)

Age: Years, Months

Type of Pet (required) :

Breed: (required)

Sex: (required)

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Are your pets vaccines current?

Do you have pets medical records?

Medical records at another veterinary Practice?

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Name of Former Veterinary Practice

May we request a transfer of records?

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Special requests or conditions?

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HOURS

Mon-Tues	8 am	5 pm
Wed	8 am	3 pm
Thurs	12 pm	5 pm
Fri	8 am	3 pm
Sat	Closed
Sun	Closed

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