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Pet Portal|(603) 329-7825

Services
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Pet Portal
(603) 329-7825

Services
Hours & Location
About Us
Contact

New Client Form

Complete our new client form to request an appointment and a member of our client service team will contact you. We look forward to meeting you and your four-legged family members!

Please note this is simply a request and your appointment will be confirmed when you are contacted by a member of our team.

If you are in need of immediate assistance, please contact us directly at (603) 329-7825.

Co-Owner Name (first & last):

Co-Owner Phone Number:

How did you hear about us?

Internet Search

Drive By

Client Referral

Other

If you were referred by a client, what is their name?

Patient Information:

Pet's Name*

Age / DOB*

Species*

Cat

Dog

Breed*

Color*

Sex*

Female Intact

Female Spayed

Male Intact

Male Neutered

What is the reason for your visit?

I understand that my pet’s picture may be used on social media sites.*

YES, you can use my pet's photo on social media.

NO, do not use my pet's photo on social media.

New Hampshire law requires Rabies vaccinations for ALL dogs and cats over 12 weeks of age, even pets that are strictly indoors. As a patient of Hampstead Animal Hospital, we require Rabies and canine DHPP/feline FVRCP (distemper vaccine) to be kept up to date in order to continue receiving hospital services. Please be aware that if your pet is not up to date on these core vaccines, your veterinarian will require updating them at your appointment. We will gladly provide a written treatment plan of service fees if you wish; please ask. By signing this form, I state that I am over the age of 18, that I am the owner of this pet or acting as an agent for the owner, and that I assume full financial responsibility for goods/services rendered. We accept Cash, Visa, MasterCard, Discover, American Express, and Care Credit.
~ALL FEES ARE DUE WHEN SERVICES ARE RENDERED~*

I have read and accept

Hampstead Animal Hospital

5 Hazel Drive
Hampstead, NH 03841

phone: (603) 329-7825
email us

Veterinarians serving the Hampstead, NH area, including (but not limited to): Atkinson, Plaistow, Sandown, Windham, Salem, Derry, Danville, and Chester.

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