Email

Secondary Email

How did you hear about us?

Pet(s) Information

Pet Name #1

Breed

Age or Date of Birth

Color or Markings

Pet Name #2

If applicable

Breed

Age or Date of Birth

Color or Markings

Additional Pets

If you have more than two pets, please email their information to frontdesk@miltonawc.com.

Pet Records

Please have your prior clinic email your pet’s records to us at frontdesk@miltonawc.com

Treatment Authorization

By sending the above form, I hereby authorize the staff of Animal Wellness Clinic to render any treatment that is deemed necessary to my pet(s) health while in the custody of the clinic. I understand that in the event of any unusual or emergency circumstances, the staff will make every attempt to contact me or my designated representative before, if time permits, proceeding with treatment. I understand that I will be financially responsible for all emergency procedures including the Estimate of Charges provided to me in person or over the telephone. I understand that professional fees are to be paid at the time services are rendered and a deposit is required on all pets admitted to the clinic.

New Client Form

Welcome to our clinic!

678-587-5171