Is your pet coming in for a Procedure?

You can fill out this annual exam form and securely online by filling in the form below.

All questions with an asterisk after the question require an answer for this form to be submitted properly.

By clicking on the submit button above, I hereby authorize Plaistow-Kingston Animal Medical Center to perform such diagnostics, therapeutic and surgical procedures as described above. The nature of such services has been described to me to my satisfaction and I realize that no guarantee nor warranty can ethically or professionally be made regarding the result or cure. I also authorize the clinic staff in an emergency situation, to follow through with such procedures as are necessary for the well being of my pet on a continuing basis until further communication with me. I understand that I assume financial responsibility for all services rendered.