Open Mon-Fri: 8:00AM to 5:00PM, Sat: 8:00AM to 1:00PM

New Client Intake Form

  • Client Information

  • Patient Information

  • Please read carefully below:

    I, the owner of the pet listed above, understand that payment is due upon completion of services. MVMC does not offer any payment plan options. MVMC does accept Visa, MasterCard, American Express, Care Credit and personal checks. A deposit of 50% of the signed estimate is required for all patients upon admission to the hospital.

    There is a $25 returned check fee on any check returned for insufficient funds.

    A 1.5% monthly interest charge will be placed on balances left with MVMC.

    If my account remains unpaid and sent to collections, MVMC reserves the right to add 50% of the balance due to the existing account for the cost of collection.

    I have read the above information and agree to abide by these conditions

  • Date Format: MM slash DD slash YYYY
  • Due to our compliance with the Maine Prescription Monitoring Program, by providing your date of birth you are consenting to a prescription search that is mandatory when prescribing certain medications.

  • Date Format: MM slash DD slash YYYY