Coastal Valley Veterinary Services

PO Box 1015
Old Lyme, CT 06371

(860)867-6367

www.coastalvalleyvet.com

PLEASE NOTE
Coastal Valley Veterinary Services is currently closed to new clients. However, we are still providing at-home euthanasia services to all clients whether or not you have a pre-existing relationship with CVVS. 

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

New Client

Name (required)
First Name (required)
Last Name (required)
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 :
Pet's Name (required)

Age: Years, Months (or date of birth if known)

Species (required) :
Breed:

Sex: (required)

Male
Female


Neutered/Spayed

Neutered
Spayed


Are vaccines current?
Do you have medical records?
Medical records at another Veterinary Practice?

Yes
No


Name of former Veterinary Practice

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 animals here


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