Holmes Family Veterinary Clinic

2245 Providence Highway
Walpole, MA 02081

(508)921-3626

www.holmesfamilyvet.com

Current client- New Patient Form

Owner's Name (required)
First Name (required)
Last Name (required)
Preferred Telephone (required)
Phone TypePhone Number (required)
Secondary Telephone/Cell
Phone TypePhone Number
E-Mail Address :
Pet's Name: (required)

Date of Birth or Estimated Age: (required)

Type of Pet: (required) :
Breed:

Color:

Sex:

Male
Female
Unknown


Spayed/Neutered?

Yes
No


Are your pet's vaccines up to date?
Do you have your pet's medical records?
If we have not received your pet's medical records, may we request them from your previous veterinarian?

Yes
No


Name of Former Veterinary Practice:

Reasons or conditions that prompted your visit?

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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