Hooksett Veterinary Clinic, Inc.

HOURS

Day	Open	Close
Monday	8:00am	6:00pm
Tuesday	8:00am	6:00pm
Wednesday	8:00am	1:00pm
Thursday	8:00am	6:00pm
Friday	8:00am	6:00pm
Saturday	*9:00am	1:00pm
Sunday	Closed	Closed

*We are open every other Saturday. Please call for availability.

After Hour Calls

Calls will reach a recorded message providing Emergency Clinic options.

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59 Pleasant St.
Hooksett, NH 03106

(603)485-8412

www.hooksettvet.com

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 cooperation in letting us assist you.

New Client

Name *(required)*

First Name (required)	Last Name (required)

Address (required)
Street Address (required)

City (required) ,	State / Province (required)	Zip / Postal Code (required)

Daytime Phone (required)
Phone Type	Phone Number (required)

Evening Phone (required)
Phone Type	Phone Number (required)

E-Mail Address (required) :

Pet's Name (required)

Age: Years, Months (required)

Type of Pet (required) :

Breed & Color: (required)

Sex: (required)

Male
Female

Neutered/Spayed (required)

Neutered
Spayed
Neither

Are your pets vaccines current?

Do you have pets medical records?

Medical records at another veterinary Practice? (required)

Yes
No

Name of Former Veterinary Practice (required)

Have you called this practice to allow a transfer of records? (If no, please do and have them sent prior to your scheduled appointment with us) (required)

Yes
No

Reasons or conditions that prompted your visit? (required)

Special requests or conditions? (required)

Please list any additional pets here

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