Please Note: We will be closed on Thursday, November 28th and Friday, November 29th in observance of Thanksgiving!

New Client Form

Name: Brimfield Veterinary Services
Address: 1094 Tallmadge Road, Kent, OH, 44240, United States
Telephone: 330-678-3112
Price range: $

Save time during your next appointment! Complete your required forms online from any device at any time before your visit.

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New Client Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit. If this is an emergency, or if your pet needs urgent care, please call us at 330-678-3112 for a faster response.

Name *

First

Last

Email *

Primary Phone *

Secondary Phone

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Who else is authorized to make decisions about your pet's healthcare? *

First

Last

Phone

How did you find out about our hospital? If you were referred by someone, who should we thank? *

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Payment is due in full at the time that services are performed. If being admitted into the hospital, we cannot begin the care of your Pet until you have confirmed your desire to do so by 1) signing the client consent & estimate form, and 2) leaving an initial deposit of 50% of the upper end of the estimate. This is the only way that we have of knowing for certain that you want us to proceed with the care of your Pet. We accept Cash, Visa, MasterCard, and Discover. We neither extend credit, nor bill for services. All open invoices are sent to collections after 45 days unless prior arrangements are made. *

I have read and accept the financial policy.

Website

New Client Form

New Client Form

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Address

Contact

Hours

Monday & Wednesday

Tuesday

Friday

Thursday, Saturday & Sunday

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