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New Client Form

Save time during your next appointment. Complete your new client form 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 pets before your visit.

Owner's Name *

Partner/Co-Owner's Name

Address *

Address Line 1

City

State

Email *

Primary Phone *

May we text this number? *

Partner/Co-Owner's Phone

May we text this number?

Previous Veterinarian Name *

Previous Veterinarian Phone

How did you hear about us? *

Word of mouth
Internet search
Social Media
Mailer/Local Advertisement
Other

Who can we thank for the referral? *

If other, please specify *

Pet Information

Pet's Name *

Species *

Age/Date of Birth *

Breed *

Color *

Sex *

Do you have a second pet? *

Second Pet Information

Pet's Name

Species

Age/Date of Birth

Breed

Color

Sex

Do you have a third pet? *

Third Pet Information

Pet's Name

Species

Age/Date of Birth

Breed

Color

Sex

Please feel free to include any additional pets' information in your email reply.

I grant permission to Westside Animal Hospital and it's staff to use my pets' photographs for the clinic's website and/or social media pages. *

Please Review our Hospital Policies

Our team is committed to treating all clients with dignity and respect. We do ask that you give our team the same consideration. For the safety and well-being of the patients in our care, other clients, and our team, we will not tolerate cursing, yelling and/or any attack on our staff. Failure to act in a calm and respectful manner may result in the termination of your relationship with Westside Animal Hospital. *

Payment is required at time of service. We accept all major credit cards, cash, CareCredit, and Scratch Pay. *

If you are late to arrive for your scheduled appointment you may be asked to reschedule. *

We require 24-hour notice for ALL cancellations or reschedules. If you cancel or reschedule without a 24-hour notice or no-show for your appointment, a no-show fee will be applied to your account. *

I hereby authorize the veterinarians at Westside Animal Hospital 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 understand that these charges must be paid at the time of release and that a deposit may be required for surgical procedures and treatment. *

Signature *

Clear Signature

Date *

Name

Book an Appointment

We proudly serve the pets of Cumberland, Yarmouth, North Yarmouth, Windham, Falmouth, Gray, Gorham, Westbrook, Portland, Auburn, Lewiston, Litchfield, Scarborough, Cape Elizabeth, South Portland, Saco, and the surrounding areas. We look forward to seeing you and your pet. Request an appointment by clicking the button below.

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Questions?

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

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Location

172 Gray Rd
Cumberland, ME 04021

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Contact Information

Phone: (207) 829-4090
Email: info@westsideah.com

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Hours

Mon-Fri: 8:00 am – 6:00 pm
Sat: 8:00 am – 2:00 pm
Sun: Closed

Name *

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Last

Email *

Phone

How can we help you? *

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