Cohutta Animal Clinic
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Our Facility
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Dentistry
Diagnostic Lab Services
Digital Radiology
Microchipping
Nutritional Counseling
In House Pharmacy
Surgery
Dog Vaccines
Wildlife Triage
KANGEN WATER
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Request A Refill
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NEW PATIENT FORM
*
Indicates required field
Pet Owner's Name
*
First
Last
Home Phone Number
*
Cell Phone Number
*
Spouse's/Partner's Name
*
First
Last
Work Phone Number
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Email
*
Who may we thank for you Referral?
*
Choose One
*
Male
Female
Neutered Male
Spayed Female
Breed
*
Color &/or Markings
*
Pet's Name
*
Species
*
Dog
Cat
Bird
Rabbit
Reptile
Ferret
Llama
Other
Pet's Age
*
Pet's Birthday
*
Reason for visit
*
Previous Vet
*
Previous Vet's Phone Number
*
By clicking
SUBMIT
below, I am authorizing the veterinarian to examine, prescribe for and treat the above-described pet. I assume full responsibility for the charges incurred in the care of this animal. I also understand that these charges will be paid at the time of release and that a deposit may be required for extensive treatment. Furthermore, in accordance with the Georgia Veterinary Practice Act regarding the confidentiality of patient medical records, I authorize the release of my pet's vaccination and other medical records by Cohutta Animal Clinic as my pet's circumstances warrant to the following: Boarding kennel, Groomer, Veterinary Specialty (Referral) Practices, or Other Veterinary Clinics.
Submit
Home
About
Our Facility
Our Team
Services
Dentistry
Diagnostic Lab Services
Digital Radiology
Microchipping
Nutritional Counseling
In House Pharmacy
Surgery
Dog Vaccines
Wildlife Triage
KANGEN WATER
Contact & Location
Forms
Request an Appointment
Request A Refill
New Patient Form
Resources
Useful Links
FLEAS/HEARTWORM FAQ
Payment/Refund FAQ
Emergency FAQ
GENERAL FAQ