If your pet is new to Wachusett Animal Hospital and Pet Retreat, please use one of the options below to fill out our New Patient Form.

Option 1

Complete Online

Complete and submit the online form below.

Option 2

Print & Complete

Bring the completed form with you to our hospital.

Download Form

Option 3

Complete on Arrival

If you prefer, fill out the form when you get to our hospital.

New Patient Form

Owner Information

Owner First Name *

Owner Last Name *

Secondary Owner / Spouse's Name

Email *

Primary Phone *

Mobile Phone

Work Phone

Address *

City *

State *

Zip Code *

How did you hear about us? *

Primary Care Veterinarian

Internet

Friend / Family

Community Event

Signage

Printed Publication

Radio

Other

If you have another Primary Vet, please list their name/animal hospital here:

Would you like to join our emailing list? *

Yes

Emergency Contact

Primary Emergency Contact Name *

Primary Emergency Contact Phone *

Secondary Emergency Contact Name

Secondary Emergency Contact Phone

Do you authorize your emergency contact(s) to make urgent treatment decisions if you are unreachable? *

Yes

Do you authorize your emergency contact(s) to receive patient information in addition to your primary care veterinarians? *

Yes

Pet Information

1st Pet's Name *

Birth Date / Age *

Species *

Breed / Other Species *

Color

Vaccination Status *

Gender *

Spayed or Neutered? *

Presenting problem, special needs, concerns *

2nd Pet's Name *

Birth Date / Age *

Species *

Breed / Other Species *

Color *

Vaccination Status *

Gender *

Spayed or Neutered *

Presenting problem, special needs, concerns *

Primary Veterinarian Information

Please fill this section in if we are not your primary care veterinary hospital. By listing your primary care veterinarian, you are authorizing Wachusett Animal Hospital & Pet Retreat to release patient information to the primary care hospital or veterinarian.

Primary Care Facility

Primary Care Veterinarian(s)

By submitting this form, I hereby authorize Wachusett Animal Hospital & Pet Retreat to render medical care for my pet(s) as deemed necessary by the veterinarian. I understand that no guarantee can be given to the outcome of treatments and take it as my responsibility to comprehend any risks involved. I agree to pay for the cost of all services to which I consent to by written or verbal estimate. I understand that a deposit is required before diagnostics and treatments can be initiated and that payment in full is required prior to discharge of patient from Wachusett Animal Hospital & Pet Retreat.

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Patients

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Happy Tails from Clients

The best quality care available. The kind and compassionate staff treat you and your pets exceptionally. These people really care and go above and beyond for you and your pet. I have used all the services here for years, from regular visits to emergency and end of life, also the wonderful pet retreat. 5 stars all around.
- Brett C.

AAFP Certified Emergencies Patient Account Login Log in to your pet's patient account to book an appointment, refill a prescription, or access your pet's medical records.

New Patients Welcome

Wachusett Animal Hospital and Pet Retreat is accepting new patients! Get in touch today to book your pet's first appointment.