Due to being at client capacity and wanting to continue to deliver exceptional service to our existing clients, we are no longer accepting new clients at this moment. We appreciate your understanding.

South Windsor Veterinary Clinic

New PET Form

Save time during your next appointment! Complete your required forms online from any device at any time before your visit.

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New PET Form

Please fill out South Windsor Veterinary Clinic’s form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

Pet Owner Information:

First Name *

Last Name *

Spouse *

Street Address *

Address Line 1

Address Line 2

City

State

Zip Code

Home telephone: *

Work telephone: *

Cell telephone *

Email address: *

Pet Name: *

Species *

Dog
Cat
Other

Breed *

Color *

Birthdate/Age: *

Sex: *

Male
Female

Spayed/Neutered: *

Any previous serious illnesses or surgeries? *

Any allergies to vaccinations or medications? *

Is your pet on any special diets or medications? *

When calling with information/results for your pet, is there a preference regarding who we talk to? If Yes please list name and number of contact; *

In Connecticut, all dogs and cats over the age of 3 months are required by law to be vaccinated against rabies. Is your pet current on his or her rabies vaccination? *

Yes (must provide proof)
No (my pet will need the rabies vaccination)

I hereby certify that I am the owner or authorized agent of the above pet. I hereby authorize the veterinarian to examine, prescribe for, and/or treat the above described pet. I assume responsibility for all charges incurred in the care of this animal. I also understand that all professional fees are due at the time services are rendered and a deposit may be required for surgical procedures.

Owner Signature: *

Date *

Social Media Consent *

I hereby give South Windsor Veterinary Clinic permission to use photographs taken of me and my pets for the purpose of posting on South Windsor Veterinary Clinic’s Facebook, YouTube, Twitter, Instagram and the clinic website. I hereby release and discharge South Windsor Veterinary Clinic from any and all claims arising out of usevof the photos and/or videos.
I DO NOT give permission

Owner Name: *

Pet Name: *

Signature: *

Date *

Health Records Policy

To ensure the confidentiality of patient medical records, a written authorization is required in order for South Windsor Veterinary Clinic to produce copies of your pet’s medical records:

Owner Name: *

Pet Name: *

I attest that the above pet is owned by me and I authorize the South Windsor Veterinary Clinic to release any medical records upon my request.

Yes
No (fees may apply)

Signature: *

Date *

Which form of payment would you prefer to use? We accept the following: *

Cash
Mastercard
Visa
American Express
Discover
Care Credit

Please be aware we do not accept personal checks. Payment is due at the time of services.

**Did you know that if your email is registered with us in your patient file you can access your pets’ records from our website. This user friendly site will provide you with your vaccination history, names of dietary items you have purchased with us, medications dispensed, when your pet is due next and a chronological history of services.

Phone

Have A Question?

Fill out our online form, and a member of our team will get back to you as quickly as possible.

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Contact

P: (860) 644-3224
E: contact@swvc-online.com
Fax: (860) 644-8050

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Location

69 Oakland Road South Windsor, Connecticut, 06074

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Opening Hours

Monday – Friday: 8:00am – 5:30pm
Saturday & Sunday: Closed
* On Wednesdays from 8:30-9:30 am we are in an all-staff meeting

Name *

First

Last

Email *

Phone

How can we help you? *

Website