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Let’s Talk! (860) 980-3047

New Patients

Please fill out this form before coming into the office. If you prefer a PDF is available for download.

Download PDF

Fields marked with an * are required.

Your First Name: *

Your Last Name: *

Pet(s) Name(s): *

What brings you to Northeastern Veterinary Care Center?

Does your pet have any pre-existing medical conditions?

Is your pet on any medications/supplements? If so, please list

What do you feed you pet and how often? (Brand name, Dry/Canned)

Have you changed food recently?YesNo

What type of treats do you give your pet and how often?

Is your pet on flea and tick control?YesNo

If so, which brand and where is it purchased?

How often do you administer the flea/tick meds?

Is your pet itchy?YesNo

If you answered "yes" that your pet is itchy, what locations on their body?

On a scale of 1-10 (1=least, 10= most), how itchy is your pet?

Did you know we have an online store?YesNo

Do you allow pictures of your pet to be posted on our social media accounts (i.e., Facebook, Instagram, Etc.)YesNo

Dogs Only

Is your dog on heartworm preventative monthly?YesNo

If so, which brand and where do you purchase this?

Is your dog (select all that apply):

Cats Only

Is your cat:

Does your cat:

Please do not fill in this field.

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APPOINTMENT HOURS

Tuesday – Friday: 10:00AM – 4:00PM
Saturday: 11:00AM – 4:00PM

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VISIT US

144 Whitehall Avenue
Mystic, CT 06355
Also serving Groton, CT and surrounding areas.

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CONTACT US

Phone: (860) 980-3047
Email: [email protected]

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