New Client Form

To help us better serve our new clients we ask for you to complete our New Client Form online and complete before your scheduled appointment. This will allow us to focus on the health of your pet upon your arrival. If you have any questions or concerns please contact the hospital by calling us at (860) 693-0214 or email info@RoaringBrookPet.com

Download Printable PDF Version

Contact Information

* Full Name

Spouse / Significant Other

* Address

* City and Zipcode

* Email Address

* Phone Number

* Place of Employment

* Work Phone Number

* Alternate Contact

* Phone Number

Let's stay in touch! Please select your preferred method of contact:

We love to share! Does Roaring Brook Veterinary Hospital have permission to post your pet's picture on social media?

How did you become aware of Roaring Brook Veterinary Hospital

Personal Recommendation - Who may we thank?

Previous Veterinarian - Who may we thank?

Advertisement - Where did you see it?

Website or Social Media - Please specify where:

Roaring Brook KennelsHospital Sign

Payment Information

All fees are due at the time of service, or upon release of the patient. The undersigned agrees to pay finance charges of 1.5% per month (18% APR) plus billing fees, court costs and attorney fees on any unpaid balance.

* Please select your preferred method of payment: (We accept Visa, Mastercard, Discover, American Express and Care Credit

* Signature

* Date