New Client Application

Save time by filling out your forms online! Our new client application is available here to fill out at your convenience.

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New Client Application

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

Name *

First

Last

Email *

Primary Phone *

Secondary Phone

Work Phone

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Preferred method of correspondence

Email
Phone
Text

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

First

Last

Phone

Pet information #1

We want to learn all about your pet!

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Color *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

What is the microchip number?

Please name medication, dosage, and frequency (write "none" if not applicable) *

Please name flea, tick, and/or heartworm preventative medication (write "none" if not applicable) *

Please contact your previous veterinarian and request complete medical history. We require animal's history 72 hours prior to appointment time. *

I will contact my previous vet
I do not have a previous vet

Previous vet's name and phone number *

Do you want to add another pet? *

Pet information #2

We want to learn all about your pet!

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Color *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

What is the microchip number?

Please name medication, dosage, and frequency (write "none" if not applicable) *

Please name flea, tick, and/or heartworm preventative medication (write "none" if not applicable) *

Please contact your previous veterinarian and request complete medical history. We require animal's history 72 hours prior to appointment time. *

I will contact my previous vet
I do not have a previous vet

Previous vet's name and phone number *

Do you want to add another pet? *

Pet information #3

We want to learn all about your pet!

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Color *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

What is the microchip number?

Please name medication, dosage, and frequency (write "none" if not applicable) *

Please name flea, tick, and/or heartworm preventative medication (write "none" if not applicable) *

Please contact your previous veterinarian and request complete medical history. We require animal's history 72 hours prior to appointment time. *

I will contact my previous vet
I do not have a previous vet

Previous vet's name and phone number *

"Ruff"eral Section *

Canton Neighbors Facebook
Facebook
Google Search
Walk/Drive by
Word of mouth
Yelp
Client Referral
Event Flyer/Postcard
Other

Please specify *

Consent for Services

When you arrive at our hospital, you will be asked to sign a Consent for Services. In the meantime, click here to read over our financial & scheduling policies. Let us know if you have any questions.

Check box to acknowledge *

I acknowledge

Additional Comments

Please use the space below to share any additional information about your pet(s) you deem applicable.

Write your comments here:

Name

Ready for a Visit?

We want people and their pets to feel at home at our Baltimore, Maryland, animal hospital. With the most recent technology and innovative treatment methods, we advance veterinary medicine without sacrificing the sense of community essential to providing high-quality patient care. We place a high priority on attending to your pets’ needs and comprehending your worries.

Easily request an appointment for your pet using our online system on PetDesk and keep up with your pet’s health by downloading our app!

Book Appointment Download App

Have a Concern?

Please feel free to ask us a question using our online form, and a member of our team will be in touch with you soon.

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Location

Natty Boh Tower
3600 O’Donnell Street, Suite 160
Baltimore, MD 21224

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Contact Information

Phone: 667-354-1143
Email: CCVH@charmcityvet.com

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Hours

Mon: 8:00am – 6:30pm
Tue & Wed: 8:00am – 4:00pm
Thurs: 8:00am – 5:30pm
Fri: 8:00am – 3:00pm
Sat-Sun: Closed

Name *

First

Last

Email *

Phone

How can we help you? *

Website