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New Patient Form

If this is your first time taking your cat or dog to see our vets at Mill Plain Veterinary Clinic please complete and submit our New Patient Form below.

Option 1

Complete Online

Complete and submit the online form below.

Option 2

Print & Complete

Bring the filled-out form with you to your appointment.

Download Form

New Patient Form

IMPORTANT: Please call our office to book an appointment before filling out this form.

Owner Information

Emergency Contact

Patient Information

Primary Veterinarian Information

Please fill this section in if we are not your primary care veterinary hospital. By listing your primary care veterinarian, you are authorizing Mill Plain Veterinary Clinic to obtain and/or release patient information to the primary care hospital or veterinarian.
By submitting this form, I hereby authorize Mill Plain Veterinary Clinic to render medical care for my pet(s) as deemed necessary by the veterinarian. I understand that no guarantee can be given to the outcome of treatments and take it as my responsibility to comprehend any risks involved. I agree to pay for the cost of all services to which I consent to by written or verbal estimate. I understand that a deposit is required before diagnostics and treatments can be initiated and that payment in full is required prior to discharge of patient from Mill Plain Veterinary Clinic.

New Patients Welcome

Are you looking for a veterinarian for your cat or dog in Danbury? Mill Plain Veterinary Clinic is now accepting new patients! Contact us today to schedule an appointment.

(203) 790-8387 Contact