Milton Veterinary Hospital PC

622 Route 29
Middle Grove, NY 12850

(518)587-4676

miltonveterinary.com

New Client Check In

If you would like to make an appointment, you can assist us to expedite your check in by submitting this form.

Thank you for your cooporation in letting us assist you.

New Client

Name (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 TypePhone Number (required)
Evening Phone (required)
Phone TypePhone Number (required)
E-Mail Address (required) :
Pet's Name (required)

Age: Years, Months

Type of Pet (required) :
Breed: (required)

Sex: (required)
Male
Female


Neutered/Spayed (required)
Neutered
Spayed


Are your pets vaccines current?
Do you have pets medical records?
Medical records at another veterinary Practice?
Yes
No


Name of Former Veterinary Practice

May we request a transfer of records?
Yes
No


Would you like us to call you for your appointment
Reasons or conditions that prompted your visit?

Special requests or conditions?

Please list any additional pets here

Please Read
I understand, by indicating I agree and submitting this registration, that I am responsible for any charges incurred by my pet while in the care of the doctors at Milton Veterinary Hospital PC and that charges are due and payable at the time of service.
I have read this statement and -
I Agree
I Disagree



Check the reCAPTCHA to ensure you are not a robot:


HOURS

Mon-Tues

8 am

6 pm

Wed

8 am

5 pm

Thurs

12 pm

5 pm

Fri

8 am

5 pm

Sat

9 am

12 pm

Sun

Closed


 

Get Directions

 

Tell your friends about us!