New Client Form

Co-Owner Name (first & last):

Co-Owner Phone Number:

Patient Information:

Pet's Name

Age / DOB

Species

Breed

Color

Sex

Female Intact

Female Spayed

Male Intact

Male Neutered

General Information

Previous Veterinarian and 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?

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.

Reason for your pet's visit:

Poland Animal Hospital

1197 Maine Street Poland, ME 04274 email: PolandAH@yourvetdoc.com phone: (207) 998-2444 fax: (207) 998-8149

Serving the Poland, ME including (but not limited to): Casco, Gray, Mechanic Falls, Minot, New Gloucester, Oxford, and Raymond.

Office Hours

Monday: 8:00am - 5:00pm

Tuesday: 8:00am - 5:00pm

Wednesday: 8:00am - 5:00pm

Thursday: 8:00am - 5:00pm

Friday: 8:00am - 5:00pm

Saturday: 8:00am - 12:00pm

Sunday: Closed

View emergency pet care information

View our holiday hours and closings >

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