New Client Form

The Vet and Rehab Center of Cape Elizabeth

207 Ocean House Road
Cape Elizabeth, ME 04107

(207)799-6952

www.vrcce.com

New Client

If you would like to make an appointment, please assist us by submitting this form prior to that time. This will allow us more time to concentrate on your pet.
Thank you for your cooperation.

New Client

Name & Email (required)

First Name (required)	Last Name (required)

Address (required)
Street Address (required)

City (required) ,	State / Province (required)	Zip / Postal Code (required)

Daytime Phone (required)
Phone Type	Phone Number (required)

Evening Phone (required)
Phone Type	Phone Number (required)

E-Mail Address :

Pet's Name (required)

Date of Birth (M/D/Y)

Type of Pet (required) :

Breed:

Sex: (required)
Male
Female

Neutered/Spayed
Neutered
Spayed

Are your pet's vaccines current?
Yes
No

Do you have your pet's medical records?
Yes
No

Are your pet's medical records at another veterinary practice?
Yes
No

Name of Former Veterinary Practice

May we request a transfer of your pet's records?
Yes
No

Reasons or conditions that prompt this exam?

Special requests or conditions?

Please list any additional pets here...

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Our Hours

Mon-Fri 8-6
Saturday 8-1
Closed Sunday

Click for directions!

Please call 207-799-6952 for emergencies or appointments.

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