Manchester Veterinary Clinic

156 Spencer Street
Manchester, CT 06040

(860)646-5170

www.manchestervetclinic.com

New Patient Information

 

Welcome to MVC!

We are accepting new clients.

Please complete the new patient form to start the scheduling process.

If you have more than 1 pet to add to your potential account, complete the additional pet form for each of your pets.

 

If you have additional pets, please complete this form <CLICK HERE>

 Welcome to MVC!

 

 

New Patient

Owner Name (required)
First Name (required)
Last Name (required)
Co-Owner or Spouse
First Name
Last Name
Address (required)
Street Address (required)
City (required)
,		State / Province (required)
Zip / Postal Code (required)
Primary Phone (required)
Phone TypePhone Number (required)
Additional Phone
Phone TypePhone Number
Work Phone
Phone TypePhone Number
E-Mail Address (required) :
Why are you looking for a new vet? What are you looking for in a new vet? (required)

What is your typical availability for appointments? (Note: New client appointments are scheduled Monday - Friday before 4pm) (required)

What number is best to TEXT to offer an appointment? (Sometimes openings become available short notice) (required)

How did you hear about Manchester Veterinary Clinic? (required) :
If Word of month/friend, who may we thank for your referral?

Do you qualify for our senior citizen discount (65 or older)? ***If YES, please present photo ID to our front desk team PRIOR to your appointment starting.***

Yes
No


Pet's Name (required)

Age: Years, Months

Pet's Date Of Birth (If you know it)

Type of Pet (required) :
Breed:

Color

Sex: (required)

Male
Female
Unknown


Neutered/Spayed

Neutered (male)
Spayed (female)
Not Altered
Unknown


How long has your pet been part of your household?

Reasons or conditions that prompted your visit?

Special requests or conditions?

Where was previous veterinary care provided? (required)

Do we have permission to call for your pet's records? (required)

YES
NO
No prev. vet or prev. unknown


Please provide the previous vet's phone number or city/state they are located. (required)

We send service due reminders and appointment confirmations by email and text. Please let us know if you do not have access to at least one of these methods.

I'm good with email or text reminders/confirmations
I need an alternative option


We sometimes take photos. Please let us know if you prefer us to not take or use your pet's photos on our website, facebook, instagram and other marketing and fun platforms. (required)

I would like MVC to take my pet's photos
I would like MVC to only take photos for medical purposes


Parasite control is important, we recommend that you bring a fresh stool sample to your visit.
Payment is due at the time of service; for your convenience we accept all major credits, debit cards, cash and CareCredit.

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