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New Patient Form

Please fill out our New Patient Form using one of the options below if your pet is a new patient at Cumberland Animal Clinic.

Option 1

Complete Online

Complete and submit the online form below.

Option 2

Print & Complete

Bring the completed forms with you to our hospital.

Patient Information

Client Information

Option 3

Complete on Arrival

If you prefer, fill out the forms when you get to our hospital.

New Patient Form

Owner Information

Emergency Contact

Patient Information

Primary Veterinarian Information

Please fill this section in if we are not your primary care veterinary hospital. By listing your primary care veterinarian, you are authorizing Cumberland Animal Clinic to release patient information to the primary care hospital or veterinarian.
By submitting this form, I hereby authorize Cumberland Animal Clinic to render medical care for my pet(s) as deemed necessary by the veterinarian. I understand that no guarantee can be given to the outcome of treatments and take it as my responsibility to comprehend any risks involved. I agree to pay for the cost of all services to which I consent to by written or verbal estimate. I understand that a deposit is required before diagnostics and treatments can be initiated and that payment in full is required prior to discharge of patient from Cumberland Animal Clinic.
I understand that payment for all services and goods from Cumberland Animal Clinic is due at the time they are received unless prior arrangements have been made. I agree to pay, either with cash, Visa, MasterCard, American Express, or Discover. Should there be an outstanding balance on my account, I understand that I will be charged, and agree to pay, a 1.5% per month (18% APR) finance charge.

New Patients Welcome

Are you looking for a vet in Smyrna, Georgia? Cumberland Animal Clinic is accepting new patients! Our experienced vets are passionate about animal healthcare. Get in touch today to book your pet's first appointment.

(770) 433-1414