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If you are new to our practice and would like to request an appointment please fill out the following form and we will call you within 48 hours. Our new client appointments are typically booked out 4-5 weeks based on availability

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New Client Request Form

Owner's First Name

Owner's Last Name

Phone

Pet's Name(s)

Street Address

City

Region/State/Province

Postal / Zip code

Species of Pet(s)

Canine (Dog)

Feline (Cat)

Date of Birth or Approximate Age of Pet(s)

Breed of Pet(s)

Color/Description of Pet(s)

Sex/Altered Status of Pet(s)

Intact Male

Intact Female

Neutered Male

Spayed Female

Reason for Appointment

Additional Notes

We require a deposit of $90 at the time of booking the appointment. This will go towards the cost of the visit. If you need to cancel or reschedule we require at least 24 hours notice. Otherwise if you "no show" or cancel the appointment last minute we will take the deposit as our no show for appointment fee. This deposit only covers the cost of a wellness exam and any other charges incurred at the visit will be required to be paid that same day.

I agree to the terms & conditions

Please forward all patient records to our email kindnessah@gmail.com

Thanks for submitting! We’ll get back to you shortly.

Tel: 781-893-2800 • Address: 20 Linden Street, Waltham, MA

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20 Linden Street Waltham, MA 02452