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Please take a moment and complete the New Client Form below prior to your first appointment at Berkshire Humane Society Wellness Clinic. Providing this information will allow us to enter your information into our database.

Owner’s Information

Name
Address

In addition to the owner above, I would like to add another authorized individual.

Spouse, Co-Owner, Other

Pet’s Information

Speicies
Add a Second Pet?

We recommend that you call your vet and have them send your pet’s records to us prior to your visit in order to help us best manage your pet’s medical care.

A $40 booking fee is required when making an appointment. We’ll apply the fee at checkout to services received on the day of your appointment.

I hereby authorize the veterinarian to examine, prescribe for, or treat, the above described pet(s). I assume responsibility for all charges incurred in the care of this animal. I also understand that these charges will be paid at the time of the visit.

We accept cash, credit cards and Care Credit as payment methods.

Photo Release
I UNDERSTAND
Clear Signature
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