606-523-1099
corbinanimalclinic@yahoo.com

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- All Services
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Visit our sister practice
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Book Appointment

Home
About Us
Services
- All Services
Resources
Visit our sister practice
Contact
Book Appointment

Home
About Us
Services
- All Services
Resources
Visit our sister practice
Contact
Book Appointment

Give your pet the care they deserve with affordable monthly payments,
PLUS UNLIMITED OFFICE VISIT EXAMS AT NO EXTRA COST! ASK HOW

Online Forms

Client Registration

Save time during your next appointment! Complete your required forms online from any device at any time before your visit.

Puppy



Client Registration Form

Client Information

Owner's Name *

First

Last

Date *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Owner's Date of Birth

Primary Phone *

Secondary Phone

Email *

Employer

Emergency Contact

Emergency Contact Phone

Pet Health History

Pet's Name *

Age *

Pet's Date of Birth

Species (dog, cat) *

Breed *

Color

Sex *

Male
Neutered Male
Female
Spayed Female

Date Performed

Current medications your pet is taking:

Does your pet have a microchip identification? *

Yes
No

Vaccinated

Yes
No

What Year/Where:

Primary reason for visit:

After Pet's Phone

Prior surgeries:

Prior illnesses:

Authorization

I authorize Corbin Animal Clinic to take photos of my pet(s) and use for any lawful purpose, including, publicity purposes, illustration, advertising, and web/social media content. *

Yes
No

I understand that there is a "No Show" fee. Any office appointment I do not cancel at least 4 hours prior or I do not show up for will result in a $36.00 charge to my account. Surgery no show fees are $59.50 and must be canceled at least 24 hours in advance. After 3 no shows I will be terminated as a client. *

Yes, I understand

Corbin Animal Clinic utilizes artificial intelligence (AI)-assisted technology to help document patient visits and maintain accurate, complete medical records. This technology may assist in capturing and organizing information discussed during your pet’s appointment, allowing our veterinary team to focus more of their attention on your pet’s care. AI is used as a documentation support tool only. Our veterinary team remains responsible for reviewing medical records for accuracy and completeness. *

Yes, I understand

Signature

Clear Signature

Date

Ready to visit?

If you are searching for a trusted veterinarian in Corbin, Woodbine, North Corbin, or the surrounding areas, look no further than Corbin Animal Clinic. We are always accepting new patients and would be honored to be entrusted with your companion’s care.

Book Appointment

Have a question?

Fill out our online form, and a member of our team will get back to you as quickly as possible.

Address

1220 Cumberland Falls Hwy,
Corbin, KY 40701



Contact

Email: corbinanimalclinic@yahoo.com
Phone: 606-523-1099



Hours

Mon-Fri: 8:00 am – 8:00 pm
3rd Wednesday of Each Month: Closed from 12 pm – 1:30 pm for Staff Meetings
Sat: 8:00 am – 1:00 pm
Sun: Closed

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Phone

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