NFAH Intake Form

Have you ever brought a pet to New Fairfield Animal Hospital before?*

YesNo

Which car will you arrive in for your appointment?*

Make, Model, Color

Owner's Name*

First NameLast Name

E-mail*

This will allow us to email invoice, estimates, medical records, etc.

Main Contact Number:*

Please use the number you would like our staff to contact you while you are in the parking lot.

Secondary Contact Number:

Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

How Would You Prefer To Be Contacted?*

Phone (Main Number)Phone (Secondary Number)Email

Please note that you may be contacted by a restricted/blocked number when the doctor calls to discuss your pet. Please keep your phone on and be prepared to answer within the first 20-30 minutes after your pet has been taken inside the veterinary hospital.

We ask that you be patient as our phone lines can be quite busy during the course of the day. We thank you in advance for your understanding.

Have you or someone you've interacted with tested positive for COVID-19?*

YesNo

Have you been exposed to an individual who has symptoms of COVID-19?*

YesNo

Are you currently being quarantined for possible exposure to COVID-19 or are you waiting for COVID-19 test results?*

YesNo

I understand that New Fairfield Animal Hospital requires all clients to wear masks during interaction with our team members. Please be respectful of our hospital policy, our goal is to keep both you and our staff safe while providing the best possible care for your furry family members!*

Initial

Appointment Information Form

Please have your previous veterinarian send a copy of your pet's records to our hospital 24-48 hours prior to your scheduled appointment.

COVID-19 Acknowledgment