Please Note: We will be closed on Thursday, November 28th and Friday, November 29th in observance of Thanksgiving!

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 *

Name

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?

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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

Name *

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Last

Email *

Phone

How can we help you? *

Phone