New Client Intake Form

Name: Leominster Animal Hospital
Address: 129 New Lancaster Rd, Leominster, MA, 43560, United States
Telephone: 978-534-0936
Price range: $

We are so happy you have chosen us to be your preferred Leominster veterinarian!

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Welcome Clients!

Welcome to Leominster Hospital

We love our clients!

At Leominster Animal Hospital, you can expect state-of-the-art medical care for your four-legged companions. We believe in nurturing the human-animal bond and creating a harmonious relationship between people and animals. You can expect to be greeted by a courteous receptionist, clean exam rooms, friendly doctors, and caring technicians. We appreciate the role we get to play in your pet’s health care.

If you have any questions or comments about how we can care for your pet, please contact us today at 978-534-0936.

Client Information

Date *

Owner Name *

First

Last

Address *

Address Line 1

City

State

Zip Code

Phone Number *

I consent to receive SMS text messages from Leominster Animal Hospital. Msg & data rates may apply. Reply STOP to opt-out. *

Email *

Secondary Contact Name

First

Last

Secondary Contact Phone Number

Whom may we thank for referring you?

Is there a previous veterinary hospital that the pet has been seen, including ER visits? *

If so, please name the hospital and explain

Patient Information

Patient Name *

First

Last

Species *

Canine
Feline
Other

Birthdate/Age

Breed

Color

Sex *

Male
Female

Neutered/Spayed *

Patient Medical History

Records Must Be Sent To Us Prior To The Appointment Day.
If we do not receive the records before the appointment day, we will have to reschedule the appointment.
If you have no records, we will see the pet as if they have not received any vaccines or services before.
Records may be sent to info@leominsteranimalhospital.com or faxed to 978-534-0975. Please note that medical records must be received 2 days prior to the scheduled appointment time.

Social Media Consent

I hereby give Leominster Animal Hospital permission to take photographs and videos of my pet to publish on the hospital's Facebook, Youtube, Twitter, Instagram, and Website for educational and marketing purposes. I hereby release and discharge Leominster Animal Hospital from any claims arising out of the use of such photos and videos. *

I understand I will need to leave a deposit at the time of scheduling for the cost of the exam to secure the appointment time. *

I Understand

Financial Responsibility

I accept all financial responsibility for services to the above-named pet as well as the other pets listed on my account. I understand that full payment is required at the time of service. I have read and understood the information above. *

Client Signature

Book an Appointment

We proudly serve the pets of Leominster, MA and beyond. Book an appointment online today! If you need an immediate appointment or if you have an emergency, please call us.

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Ready for a visit?

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Address

129 New Lancaster Road (Rt. 117)
Leominster, MA 01453

Contact

Phone: 978-534-0936

Email: info@leominsteranimalhospital.com

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Hours

Mon-Thurs: 8:00 am – 6:00 pm
Fri: 8:00 am – 5:00 pm
*Sat: 8:00 am – 12:00 pm
Sun: Closed

*Open every other Saturday