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georgetownveterinaryclinic@gmail.com

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New Client Form

Initiate your pet’s wellness journey with Georgetown Veterinary Clinic by filling out our new client registration form.

New Client Form

Save time during your next appointment! Complete your required forms online from any device at any time before your next visit.

New Client Form

Name *

First

Last

Email *

Primary Phone *

Secondary Phone

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Who else is authorized to make decisions about your pet's healthcare? *

First

Last

Phone

How did you find out about our hospital? If you were referred by someone, who should we thank? *

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

Do you have a second pet? *

Yes
No

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

Do you have a third pet? *

Yes
No

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

Do you have a fourth pet? *

Yes
No

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

Do you have a fifth pet? *

Yes
No

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

Payment is due in full at the time that services are performed. We kindly ask for your understanding and cooperation in ensuring a smooth and efficient payment process. Your pet's well-being is our top priority. *

I have read and agree to the payment policy of Georgetown Veterinary Clinic.

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Ready for a Visit?

We proudly serve the pets of New Albany, Corydon, New Salisbury, Ramsey, Elizabeth, Lanesville, Louisville, Jeffersonville, Marengo, Salem, Palmyra, Greenville, Clarksville, Floyds Knobs and beyond. We look forward to seeing you and your pet! Schedule an appointment by clicking the button below.

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Questions?

Get in touch! We look forward to hearing from you.

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Location

7650 State Rd 64
Georgetown, IN 47122

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Contact Information

P: 812-951-3388

F: 812-951-0389

E: georgetownveterinaryclinic@gmail.com

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Hours

Mon-Fri: 8 am – 6 pm
Sat: 8 am – 12:30 pm
Sun: Closed

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