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Please fill out our New Patient Form using one of the options below if your pet is a new patient at Miller Clark Animal Hospital.

Book An Appointment

Option 1

Complete Online

Complete and submit the online form below.

Option 2

Print & Complete

Bring the completed form with you to our hospital.

Download Form

Option 3

Complete on Arrival

If you prefer, fill out the form when you get to our hospital.

New Patient Form

Owner Information

Emergency Contact

Patient Information

Primary Veterinarian Information

Please fill this section in if we are not your primary care veterinary hospital. By listing your primary care veterinarian, you are authorizing Miller Clark Animal Hospital to release patient information to the primary care hospital or veterinarian.
By submitting this form, I hereby authorize Miller Clark Animal Hospital to render medical care for my pet(s) as deemed necessary by the veterinarian. I understand that no guarantee can be given to the outcome of treatments and take it as my responsibility to comprehend any risks involved. I agree to pay for the cost of all services to which I consent to by written or verbal estimate. I understand that a deposit is required before diagnostics and treatments can be initiated and that payment in full is required prior to discharge of patient from Miller Clark Animal Hospital.

Welcoming New & Existing Clients & Their Pets.

(914) 698-1756 Contact

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