Existing clients who refer a new client to Whiting Veterinary Clinic will receive a $15 credit towards a veterinary service.

Annual Client Form

Save time during your next annual appointment. Complete your annual client form online from any device before your visit.

Get Started

Annual Client Form

We are pleased to welcome you to our practice. Please take a few minutes to fill out this form as completely as you can. If you have any questions, we’ll be glad to help you. We look forward to working with you in maintaining your pet’s health.

Client ID

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Telephone Numbers *

Email *

Co-owner

Other individuals authorized to make medical decisions on my behalf

I authorize photos of my pet(s) to be included on the Cumberland Animal Clinic's website, Facebook page and/or informational materials

I have read and understand

I hereby authorize the veterinarians to examine, prescribe for, or treat my pet. I assume responsibility for all charges incurred in the care of this animal. I also understand that charges will be paid at the time services are rendered and that a deposit may be required for surgical treatment.

Signature

Annual Client Form

Annual Client Form

Ready To Make An Appointment?

Questions?

Location

Contact Information

Hours