New Client Form

Please complete this form before your visit.

If you are coming for an urgent care visit, please fill out this ER-Urgent Care Form and call 203-877-3221 to speak to an Urgent Care Doctor before visiting Silver Sands Walk-In ER-Urgent Care.

Please note: Your privacy is important to us. All information received in all forms and through other communications is subject to our Patient Privacy Policy.

Pet Information

Click or drag files to this area to upload. You can upload up to 10 files.

I certify that I am the owner of the pet listed above. I certify that I am financially responsible for all veterinary fees. I certify that I am 18 years of age or older.

Certifico que soy el dueño de la mascota mencionada anteriormente. Certifico que soy financieramente responsable de todos los honorarios veterinarios. Certifico que tengo 18 años de edad o más.