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New Patient Form

If your pet is a new patient at our hospital, please fill out our New Patient Form using one of the options below. 

Complete Online

Complete and submit the form below.

Print & Complete

Bring the completed form with you.

Download Form

Complete on Arrival

If you prefer, you can complete the form when you get to our hospital.

New Patient Form

Please provide us with the following information. 

Client Information

Patient Information

Primary Veterinarian Information

Photography Release Form

Atlantic Coast New York Veterinary Specialists uses public social media forums, as well as other digital and print media to promote pet health, educate the community about our services, and share the faces and stories of our beloved patients.

Payment Information

I understand I am financially responsible to Atlantic Coast New York Veterinary Specialists for all charges. I understand that payment is due in full at the time services are rendered. I agree to pay all interest, collection, legal, attorney or court fees in the event it becomes necessary to pursue the account for collection. We accept cash, major credit cards and Care Credit. Unless specifically requested, all pets needed emergency care while staying in our hospital will be treated until the owner / agent can be contacted.

By submitting this form, I agree to the above.

Apply for CareCredit Financing

With CareCredit Financing, you can get your pet the veterinary care they need at Atlantic Coast New York Veterinary Specialists.

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