standard-title Welcome Form Please fill out this form prior to arrival to expedite your admission process.

Welcome Form

Please fill out this form prior to arrival to expedite your admission process.

Central Hospital for Veterinary Medicine
New Client/Patient Information

Owner Information:

First Name: Last Name:
Address:
Address 2:
City: State: Zip:
Primary Phone: Secondary Phone (Optional):
Driver's License #: Driver's License State:
E-mail Address:

Information regarding your pet will be made available to your regular veterinarian. Please provide us with his/her name and/or the clinic name.
Primary Veterinarian: Clinic:

Pet Information:

Name:
Species: Breed:
Age or D.O.B.:
Is your pet neutered or spayed? YesNoUnsureN/A
Is your pet up to date on vaccines? YesNoUnsureN/A

Please be aware that a deposit is required upon admission. Payment of the entire bill is due upon discharge. The hospital does not do any billing. Financing is available with approval through Care Credit.

How were you referred to us?
If family, friend, vet, or search engine was chosen please specify their name:
If other please elaborate:

Central Hospital For Veterinary Medicine

4 Devine Street 
North Haven, CT 06473
P: (203) 865-0878

Question, concern or comment? Please feel free to contact us. We are dedicated to providing the best care possible.

Print & Get Directions Immediately: 

Just click any of the links below for directions to the hospital. If you are on your phone or mobile device these will links will give you instant GPS directions. Call us at (203) 865-0878 if you need assistance. Our address is 4 Devine Street North Haven, CT 06473. Our Emergency, Referral and Specialty Center is Open 24 Hours a Day

  •  To get directions through Google Maps click here
  • To get directions through Yahoo Maps click here
  •  To get directions through MapQuest click here