$25 Off New Client First Exam. Learn More

New Client Form

dots

Welcome to Cumberland Animal Clinic

To help us get to know your pet and prepare for your first visit, please complete this form ahead of your appointment.

dots

"*" indicates required fields

This field is for validation purposes and should be left unchanged.

Pet Owner Information

Owner:*
Address:*

Contact:

checkbox
MM slash DD slash YYYY
Method of payment
I understand that as OWNER I am financially responsible to Cumberland Animal Clinic INC. for all charges incurred and the payment is required in full at time of services. I agree to pay a 75% deposit at the time of extensive medical care such as surgies/hospitalization.

Patient Information #1

Patient Information #2

SMS Consent
Email Consent