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Online Forms

Client Registration

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

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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

Social Security Number

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? *

Vaccinated

What Year/Where:

Primary reason for visit:

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. *

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 $25.00 charge to my account. Surgery no show fees are $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

Signature

Date

Message

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.

Appointment

Have a question?

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

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Address

1220 Cumberland Falls Hwy,
Corbin, KY 40701

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Contact

Email: [email protected]
Phone: 606-523-1099

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Hours

Mon-Fri: 8:00 am – 5:00 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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Name *

First

Last

Email *

Phone

How can we help you? *

Message