Central Park Veterinary Clinic New Client Registration Form

Central Park Veterinary Clinic

New Patient Registration Form

Congratulations on your new pet!!

We are excited to meet your new family member!

Please complete the following form in order to activate your new pet's medical record.

Note: This form is for active clients of Central Park Veterinary Clinic who have a new pet. If you are not an active client at this time (have never been here, or have not been here more than 1-2 years, or need to update your contact information), then you should be filling out our New Client Registration Form, which can be found on our website: centralparkvet.net or call us at (603)742-1203 for assistance.
Please complete this form at least 48 hours prior to your pet's first appointment so that we can save time at that visit! If we do not receive this form in time, we may need to cancel or reschedule your pet's appointment. Plus, when you come in, we want to spend less time on paperwork, and more time with you and your pet!*

I understand.
Cancellation Policy: We require at least 48 hour (2 full business days) notice to change or cancel an appointment. Clients who have a history of "no shows" or last minute cancellations may not be allowed to reschedule or may be charged a non-refundable deposit to schedule appointments. We appreciate your cooperation with this policy.*

I understand the cancellation policy

Client Information
Client Name (This is the primary owner of the pets listed with the account)*

First NameLast Name
Main Phone number or contact number listed with your account.*
This phone is a:*

Mobile phoneLandline
Email listed on the account*
example@example.com
Please list any other names or contact numbers/emails that may be listed on the account:*
Information Privacy: Central Park Veterinary Clinic provides routine communication via email, as well as by text or phone. If you choose not to list an email address, or a cell phone number, you may miss out on some communications, including vaccine reminders, appointment reminders, test results, and other valuable communications. We may occasionally send out clinic information or newsletters, but not often. We will never sell or give away any client information, including email, without your permission.

Patient Medical History

It is important that Central Park Veterinary Clinic receives copies of your pet's previous medical records prior to the day of their first appointment. This helps your appointment go more smoothly, with less time spent on paperwork and more time spent with you and your pet.

It is your responsibility to have any and all previous records sent to CPVC prior to your pet's first appointment. This may include information from a shelter/rescue, a breeder, or a veterinarian/veterinary clinic.

There are several options for sending medical records.

1. Email- you, or your pet's previous veterinarian, can email records to Central Park Veterinary Clinic. Email Address: info@centralparkvet.net

2. Bring them in! You can drop off copies of medical records right at the clinic during our regular business hours. We are located at 252 Route 108, Somersworth, NH.

If we do not receive your pet's medical records prior to the day of their appointment, your appointment will be delayed and the time required to copy and review those records may detract from the time we can spend with you and your pet! If you are having trouble geteting copies of your pet's medical records, please call us at (603) 742-1203
I will have my pet's medical records sent to Central Park Veterinary Clinic at least 48 hours (2 full business days) prior to my pet's first appointment.*

I agreeMy pet has no prior medical or vaccination history (nothing from a veterinary clinic, breeder, former owner, or rescue/shelter).
For your convenience, you may upload your pet's medical history and information here.

Cancelof
I have an appointment set up for my pet(s) on the following date (leave blank if no appointment is scheduled)

MonthDayYear
Date

Additional Comments or Notes
Is there any other information that you think we should know about you, your pets, additional pets you have, or any other comments? Please tell us! Examples: Fluffy is allergic to certain treats. Fluffy gets very nervous and might need a muzzle. Fluffy is great with people, but aggressive with other pets. Fluffy has had reactions to his vaccines in the past. Fluffy is very shy, please move slowly with him.
The staff and veterinarians at Central Park Veterinary Clinic welcome your new pet to our CPVC family. Thank you so much for taking the time to fill out these forms. We are grateful to be allowed to be a part of your family's pet care team.

Please hit the "SUBMIT" button below to complete the form.
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