New Patient 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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REGISTRATION

Owner’s/Guardian’s name *

Today’s date *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Please select primary phone number *

Home Phone
Work Phone
Cell Phone

Email *

Would you like to receive info and reminders via email? *

Spouse’s/Other’s Name & Address

Best time to call about your pet?

At what time?

At what phone *

In case of an emergency, please call

How did you hear about us?

Please describe other animals in home

Reason for visit

Is your visit for a consultation or will we be your new primary veterinarian?

I am switching care to IAHC and you will be my primary veterinarian.
I am scheduling a consult and continuing primary care with my current veterinarian.

PET HEALTH HISTORY

Pet's Name *

Date of Birth *

Type of animal *

Dog
Cat
Other

Sex *

Male
Neutered
Female
Spayed
Undetermined

Other *

Color *

Breed *

Weight *

Allergies

Vaccination History (Date and type of last vaccinations)

Upload Previous Records

Click or drag files to this area to upload. You can upload up to 5 files.

Current medications/supplements, if any

Describe your pet’s diet

AUTHORIZATION

hereby authorize the veterinarian to examine, prescribe for, or treat the above described pet. I assume responsibility for all charges incurred in the care of my animal. I also understand that these charges will be paid at the time of service and that a deposit may be required. *

I have read and accept the policy.

I grant permission toIntegrative Animal Health Center, its representatives, and employees the right to take pictures of my pet(s) to use for marketing and promotional purposes. I authorize Integrative Animal Health Center to copyright, use, and publish these photographs in both print and/or electronically. I agree that Integrative Animal Health Center may use such photographs of my pets with or without a first name and last initial (i.e.: Fluffy R.) for any lawful purpose including for example such purposes as social media content, publicity, illustration, advertising, and website content.

Signature of Owner/Guardian *

Clear Signature

Date *

Comment

Request an Appointment

We are a full-service veterinary hospital committed to giving your pets the best care possible. Click on the button to request an appointment with us today; we look forward to serving you and your pet.

Appointment

Have A Question?

Please complete the form below, and a member of our team will get back to you as quickly as possible.

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Location

556 Main St.
Bolton, MA 01740

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Contact Information

Phone: (978) 779-2955
Email: info@iahcbolton.com

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Hours

Mon-Fri: 8:00 AM – 5:00 PM
Sat: 8:00 AM – 12:00 PM
Sun: Closed

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Email *

Phone

How can we help you? *

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