New Client Request Form"*" indicates required fields Step 1 of 333%At this time Suffield Veterinary Hospital (SVH) has received a large number of requests for new clients. As our number one priority is to maintain quality care for our patients, we can only accept new clients when the schedule permits, which allows us to continue to meet the expectations of offering high standards of veterinary medicine. In order for our hospital to provide the best care possible, we do require all of your pet(s) previous medical records prior to scheduling an appointment. *Please note, a deposit is required when scheduling your first appointment.Please select yes to continue.* YesPlease note, responses to submissions may take up to 14 business days. If your pet is requiring immediate medical attention, we do recommend reaching out to the nearest 24-hour care facility. Please select yes to proceed with the new client submission request.Please select yes to continue.* YesToday's Date* MM slash DD slash YYYY Owner's Name* First Last Home PhoneCell PhoneDoes your cell phone allow text messages? Yes NoPrimary Contact Number Home Cell OtherEmail Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Pet InformationNameSpeciesBreed Add RemovePlease write a brief description of the services you are requesting for your pet(s)Do you have or can you obtain your pet(s) previous medical records? Yes NoIf yes, previous medical records will be sent via fax (860-668-4785) email/attachment mail drop off to our facilityMedical RecordsMax. file size: 256 MB.Please list below the names of the previous medical facilities where your pet(s) have received previous medical care. Add RemoveNameThis field is for validation purposes and should be left unchanged. Please check back monthly for updates.
