We are available for same-day appointments and urgent care.

New Client Form

Save time during your next appointment. Complete your new client form online from any device at any time before your visit.

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New Client Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pets before your visit.

Today's Date *

Have you ever brought a pet to West Springfield Veterinary Clinic before? *

Name *

First

Last

Email *

Primary Phone *

Secondary Phone

My secondary contact number is:

Home Number
Cell Number
Work Number
Someone else's number

Address *

Address Line 1

Address Line 2

City

State

Zip Code

How would you prefer to be contacted?

Phone (main number)
Text (main number)
Email
Phone (secondary number)
Text (secondary number)

Is there an additional person you would like listed on this account?

Additional Name *

First

Last

Above listed's Phone Number

In case of an emergency, is there anyone else (besides above listed contacts) who should be listed on your account and who has ongoing permission to make medical decisions for your pet(s)?

Emergency Contact's Name

First

Last

Emergency Contact's Phone

How did you hear about us?

Facebook
Google
Newspaper
Saw our hospital (location)

Please list who referred you so we may thank them!

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

First

Last

Pet's Name *

Species

Date of Birth/Age of Your Pet *

Breed and Color (if your cat is not a known breed, do they have long, medium, or short hair) *

Sex *

Male
Neutered Male
Female
Spayed Female

Is your pet microchipped?

Yes
No
I'm not sure

Primary reason for your visit to West Springfield Veterinary Clinic? *

Do you already have a scheduled appointment? *

Yes
No
I scheduled an appointment through your website

Previous Veterinarian/Veterinary Hospital(s) *

If none, please let us know that!

Would you like to add another pet?

Pet's Name *

Species

Date of Birth/Age of Your Pet *

Breed and Color (if your cat is not a known breed, do they have long, medium or short hair *

Sex *

Male
Neutered Male
Female
Spayed Female

Is your pet microchipped?

Yes
No
I'm not sure

Primary reason for your visit to West Springfield Veterinary Clinic? *

Do you already have a scheduled appointment? *

Yes
No
I scheduled an appointment through your website

Previous Veterinarian/Veterinary Hospital(s) *

If none, please let us know that!

Client Policies and Procedures: We want you to be aware of and understand the following policies and procedures for all clients.

We must receive your pet's medical history and records from your previous veterinarian no less than 7 days prior to your appointment; otherwise, you will need to reschedule your appointment. *

I have read and understand

We love social media! Do we have your permission to post pictures and/or videos of your pet(s), you and your pets(s), and/or your pet(s) and our team on Facebook, Instagram, Twitter, our website, and any other marketing and/or social media outlets we may choose to use? *

Our practice is currently trialing out a new AI program in order to improve our documentation of medical records so each visit is recorded in order to transfer the visit notes into our electronic records. *

I have read and understand

We require a deposit for each visit in the amount of the exam fee. We also require a 48-hour notice of desired modifications or cancellations for appointments in order to request a refund. After 48 hours, the deposit is non-refundable *

I have read and understand

West Springfield Veterinary Clinic uses email, text, and our own hospital app for communications regarding our patients' reminders for health care needs. Do we have your permission to contact you via email, text and/or our app regarding these reminders? *

Financial Policies We do not bill. All fees are due at the time that services are rendered. We accept Care Credit, Visa, MasterCard, Discover, American Express, and cash. As a courtesy, we do offer extended payment plans through the following outside sources: Care Credit and Scratch Pay.

Code of Conduct: All West Springfield Veterinary Clinic team members, clients, and patients must be treated with respect at all times. Pets must be leashed or in a carrier while in the parking lot, lobby, hallways, and any other area of the clinic where they may encounter other people and pets. Any concerns regarding your pet’s care or our client service will be addressed respectfully with a member of the management team. Please understand that emergencies and urgent visits may unexpectedly affect our schedule. We ask for your understanding as we provide life-saving care to these pets, and remember that we will do the same for your pet if/when the need arises. Please allow 72-business-hour notice for filling medication and food orders. The following behaviors will not be tolerated: verbal abuse, malicious or harmful statements about others, profanity or disrespect, any form of harassment or bullying, discriminatory comments or actions, intimidation tactics, and/or making threats. Failure to comply with the requests of our staff, including leashing/restraining your pet, etc. We reserve the right to discontinue services immediately if you are in violation of this code of conduct. *

I have read and accept the financial policy.

I have read and acknowledge the financial policies of West Springfield Veterinary Clinic. (Initials required) *

Name

Have Any Questions?

Get in touch! Complete our online form, and a member of our team will be in touch with you shortly.



Contact

P: 413-781-5275
E: info@westspringfieldvet.com

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Location

288 Westfield St.
West Springfield, MA 01089

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Opening Hours

Mon-Fri: 8:30am-5:30pm
Sat & Sun: Closed

Contact Us

Please fill out the form below and a member of our team will get back to you shortly!

Name *

First

Last

Email *

Phone

How can we help you? *

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