508-966-7605 info@uppercharlesah.com

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New Client Form

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

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New Client Form for Upper Charles Animal Hospital

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? *

Yes
No

What is the microchip number?

Do you have a second pet? *

Yes
No

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? *

Yes
No

What is the microchip number?

Do you have a third pet? *

Yes
No

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? *

Yes
No

What is the microchip number?

Do you have a fourth pet? *

Yes
No

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? *

Yes
No

What is the microchip number?

Do you have a fifth pet? *

Yes
No

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? *

Yes
No

What is the microchip number?

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, Discover, and CareCredit payments. 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.

Email

Ready for a visit?

We proudly serve the pets of Bellingham, Franklin, Hopkinton, Milford, Holliston, Hopedale, and the surrounding areas. We look forward to seeing you and your pet! Request an appointment by clicking the button below if you’re an existing client. If you’re a new client, please call us at 508-966-7605.

Request Appointment

Questions?

Get in touch! We look forward to hearing from you.

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Location

116 Mechanic St.
Unit 2
Bellingham, MA 02019

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Contact Information

Call: 508-966-7605
Text: 508-966-7020
Fax: 508-966-5254
Email: info@uppercharlesah.com

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Hours

Mon, Thurs: 8AM-8PM

Tues, Weds: 8:30AM-5PM

Fri: 8AM-5PM

Name *

First

Last

Email *

Phone

How can we help you? *

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