New Client / Referral Form from Tower Hill Animal Hospital in Auburn

New Client / Referral Form

Please fax or email us your pet’s most recent veterinary records with this form. Please state “New Client Request” on subject line or header sheet.
Email: thah@towerhillvet.com
Fax: (603) 483-2906

Client / Referral Information

Your Name

Phone Number

Email

Pet’s Name(s)

Current Veterinarian

Name of Person / Veterinarian Referring You

Reason for Visit

Please describe type of surgery requested

Please describe reason for ultrasound

Please describe reason for second opinion

Please describe other reason