Cumberland Animal Clinic

216 Greely Road
Cumberland, ME 04021

(207)829-5078

www.cumberlandanimal.com

New Client Registration

Welcome and thank you for considering Cumberland Animal Clinic for your pet's health needs!  If you would like to make an appointment, you can expedite the process and and assist us by submitting this form. We will contact you after we have reviewed your submission. In the meantime, if your pets have been seen elsewhere, please authorize your veterinarian to forward their medical records for proper review prior to your scheduled appointment here.  Thank You!

We look forward to meeting you and your pet(s)!



New Client Registration

Name (required)
First Name (required)
Last Name (required)
Address (required)
Street Address (required)
City (required)
,
State / Province (required)
Zip / Postal Code (required)
Phone Number Primary (required)
Phone TypePhone Number (required)
Phone Number Secondary
Phone TypePhone Number
E-Mail Address (required) :
Pet's Name (required)

Species (required)

Canine
Feline
Rabbit
Other


Age / Birthdate

Sex: (required)

Male
Female
Neutered Male
Spayed Female
Unknown


Breed & Color

Type of Visit Requested (required)
Wellness/Vaccinations
Medical Problem
Consultation
New Pet
New to Area / Establish Veterinary Care
Other / Additional Comments

Appointment Preference #1 :
Appointment Preference #2 :
Appointment Preference #3 :
How would you like to be contacted?

Email
Primary Phone Number
Secondary Phone Number


Medical Records
If your pet has been a patient at another veterinary practice, we would appreciate reviewing the medical records prior to the scheduled visit so we may have ample time to review your pets medical history. Please call your former practice and request that they email medical records to: cac@cumberlandanimal.com Thank You! We appreciate the opportunity to serve you and your pets.
How Did You Hear About Us?
Word of Mouth
Existing Client
Web Search
Drive By
Social Media
Other:


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