Holmes Family Veterinary Clinic

2245 Providence Highway
Walpole, MA 02081



New Client Check In

If you will be bringing your pet in for the first time, you can help us to expedite your check in by submitting this form.

Thank you for choosing Holmes Family Veterinary Clinic!

New Client

Name (required)
First Name (required)
Last Name (required)
Address (required)
Street Address (required)
City (required)
State / Province (required)
Zip / Postal Code (required)
Preferred Telephone (required)
Phone TypePhone Number (required)
Cell/Home Telephone (required)
Phone TypePhone Number (required)
E-Mail Address :
Emergency Contact Name
First Name
Last Name
Emergency Contact Telephone
Phone TypePhone Number
Please tell us how you first learned of our clinic so we can thank any individual who referred you.

Pet's Name (1): (required)

Date of Birth or Estimated Age: (required)

Type of Pet (required) :


Sex: (required)




Pet's Name (2):

Date of Birth or Estimated Age:

Type of Pet :






Are your pet(s) vaccines current?
Does your pet show any reluctance to get in the car or carrier?


How would you describe your pet's behavior during travel? Select all that apply:
Eager and excited
More quiet than usual
More vocal than usual
If other, please explain

Does your pet do any of the following during travel? Select all that apply:
Are there arny situations that your pet has tried to avoid or seemed to dislkike of in the past?
Entering the vet hospital
Unfamiliar people or animals
Being weighed
Going into the exam room
Being put up on the exam table
Having a rectal temperature taken
Ear exam/cleaning
Nail trim
If other, please explain

Has your pet ever been given any supplements or prescribed medications to help manage fear or anxiety associated with the visit. If so, what was the medication and what sort of results did you experience?

Do you have your pet's medical records?
Medical records at another veterinary Practice?


Name of Former Veterinary Practice

May we request a transfer of records?


Reasons or conditions that prompted your visit?

Special requests or conditions?

If you have already booked your appointment, please let us know the date and time:

Client/Pet Photo Release Permissions
Holmes Family Veterinary Clinic maintains an internet presence and conducts public relations activities for purposes including public education and marketing. These presences and activities often include photographs of clients and/or pets which contribute to our efforts of public education and outreach. Please let us know if you are willing to permit Holmes Family Veterinary Clinic to use photos of your pet(s) and, if appropriate, of you and your (human) family. We use only the first name of your pet in any of our materials, presentations, or internet presences.
Client/Pet Photo Release: (required) :
COVID-19 Protocols
In order to continue to serve your pets during this uncertain time and do our part to help stem the spread of coronavirus, we are asking for your help with our new protocols. Please also be patient with our staff as we all adapt to this new way of serving our clients and patients. This is an unprecedented change to the way we do things and it may take a little extra time to get through an appointment than usual. Please read through the following protocols and check yes to indicate your understand of our required protocols.
1. When you arrive at the clinic for your pet's appointment, please remain in your car and call us at 508-921-3626 to check in for your appointment.
2. We will call you from a blocked number to conduct the appointment and check you out over the phone. Please make sure your cell phone is able to accept calls from blocked numbers and the line is not in use during your appointment.
3. Please remain in the parking lot during your appointment unless otherwise directed. We have very limited kennel space for pets that are dropped off for procedures and are unable to accomodate unscheduled drop-offs.
4. All dogs must be safely secured with a collar/leash/harness and all cats, birds and small mammals must be secured in a closed carrier for transport into the clinic.
5. You will be asked to bring your pet to the door to hand to a technician when it is time for your pet's appointment. Please be sure to wear a mask that covers your nose and mouth when you are approaching the clinic or when conversing with our staff.
6. Please inform our staff at the time of booking if you or anyone in your household has had any fever, cough, or shortness of breath in the last 14 days or if anyone in your household has tested positive for COVID-19.
Please sign your name below to indicate that you have read and understand the following: Professional fees are due at the time services are provided. Please note we cannot accept personal checks for initial visits for new clients. (required)

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