New Client Form

Are you a new client to our practice? You can fill out your New Client Registration form securely online by filling in the form below.

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 603-441-5776 for a faster response.

Are you a new client to our practice?

You can fill out your New Client Registration form securely online by filling in the form below.

All questions with an asterisk * after the question require an answer for this form to be submitted properly.

We accept Cash, Check, Credit Cards, Debit, CareCredit.

Informed Consent: I will assume full responsibility for all charges incurred in the care of this pet. I understand that FULL PAYMENT IS DUE WHEN SERVICES ARE RENDERED and that a DEPOSIT IS REQUIRED FOR ANY HOSPITALIZED OR BOARDED PET. If full payment is not made as required, Plaistow-Kingston Animal Medical Center has my permission to obtain credit information from an authorized agency to aid in collections. 1.5% Monthly Finance charge and $4.00/month billing over 30 days.