New Patient Enrollment Form

Tell Us About Yourself!

Name*: First: Last:

City*: State* Zip*:

Home Phone*: County*:

Work Phone (Yours): Work Phone (Spouse):
Cell Phone (Yours): Cell Phone (Spouse):


How did you become aware of Mill Creek Animal Clinic?
InternetYellow PagesSignRecommendationLocalVets.Com

If you were referred, whom may we thank?

Location of previous records?

All fees are payable at the time of treatment or release of your pet.

By clicking this box, you accept the terms and conditions of treatment with Mill Creek Animal Clinic.