Borador Animal Hospital, PC


Our misson is to provide the highest quality veterinary care for our patients in a caring, professional and attentive manner, maintaining utmost efficiency.

HOURS

Mon:  8:00 am - 6:00 pm
Tues:  8:00 am - 7:00 pm
Wed:  8:00 am - 6:00 pm
Thurs:  8:00 am - 6:00 pm
Fri:  8:00 am - 6:00 pm
Sat:  8:00 am - 2:00 pm

www.remindmypet.com

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New Client Check In

If you would like to make an appointment, you can assist us to expedite your check in by submitting this form.

Thank you for your cooporation in letting us assist you.

Form - New Client

Name (required)
First Name (required)
Last Name (required)
Address (required)
Street Address (required)
City (required)
State/Province (required)
Zip/Postal Code (required)
,
Social Security Number

Driver's License Number (required)

Daytime Phone (required)
Phone TypePhone Number (required)
Evening Phone (required)
Phone TypePhone Number (required)
E-Mail Address (required) :
Payment Type (required)
Cash
Check
Visa
Mastercard
CareCredit

Do you qualify for a Senior Citizens Discount (60 or older)? (required)
Yes
No

Pet's Name (required)

Age: Years, Months (required)

Type of Pet (required) :
Breed: (required)

Sex: (required)
Male
Female

Neutered/Spayed
Neutered
Spayed

Name of Former Veterinary Practice

Text Block
To expedite the first visit, please provide us with any previous medical history either by fax (518) 854-3272 or mail to Borador Animal Hospital, 4321 State Route 22, Salem, New York 12865 or bring with you to the appointment.
Reason for Appointment

Special requests or conditions?

Scheduling an appointment
Please call our office at (518) 854-3005 to schedule an appointment. Our rountine surgeries are scheduled on Thursdays. Farm Calls are scheduled on Mondays and Wednesdays.
Please Read
I understand, by indicating I agree and submitting this registration, that I am responsible for any charges incurred by my pet while in the care of the doctors at Borador Animal Hospital, PC and that charges are due and payable at time of service. Any balance that is carried over a period of 30 days will accrue a monthly finance and billing charge. Any balance that I leave unpaid will be forwarded to Borador Animal Hospital, PC's collection agency, and will incur a collection fee for which I am liable, in addition to monthly finance and billing charges.
I have read this statement and - (required)
I Agree
I Disagree


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