Middlebrook Animal Clinic

9229 Middlebrook Pike
Knoxville, TN 37931

(865)691-8577

www.middlebrookanimal.com

New Client Check In

If you would like to make an appointment, you can assist us to expedite your check in by submitting this form.

However, we do ask for adequate time for our website administrator to "check" for form submissions.  If you know that your appointment may be crunched for time because of other tasks you need to complete,
make sure to call us at 691-8577 and let us know you've submitted your form. 

PLEASE BE AWARE THAT WE ARE ON CLOSED DOOR POLICY. This means that when you arrive, you will call us to let us know you are here and the spot you are in, then someone will be out to get a history and the pet. We will do the exam and all treatments inside the building while you wait or you run a quick errand. The doctor will then call and talk to you about the exam and what is either recommended or what was seen. We then have you speak to the receptionist for payment over the phone and your fur child is brought back out to you! If you have any questions about the process or why we are adhering to this, please ask!

Thank you for your patience and understanding

New Client

Name (required)
First Name (required)
Last Name (required)
Additional Name on Account
First Name
Last Name
Relationship:

Address (required)
Street Address (required)
City (required)
,
State / Province (required)
Zip / Postal Code (required)
Daytime Phone (required)
Phone TypePhone Number (required)
Evening Phone (required)
Phone TypePhone Number (required)
E-Mail Address *For access to our FREE PetPortal* :
Pet's Name (required)

Age: Years, Months

Type of Pet (required) :
Breed:

Color:

Sex: (required)

Male
Female


Neutered/Spayed (required)

Neutered
Spayed
Unknown


Are your pets vaccines current?
Do you have pets medical records?
Name of Former Veterinary Practice

Medical records at another veterinary Practice?

Yes
No


May we request a transfer of records?

Yes
No


Would you like us to call you for your appointment
Reasons or conditions that prompted your visit?

Special requests or conditions?

Please list any additional pets here


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