330-239-1271 akronmedina@yahoo.com

Facebook

Facebook

Home
About
Services
Resources
Contact
Request Appointment

Select Page

Online Form

New Client Form

Save time at your next appointment! Please complete your required New Client Form online from any device at any time before your visit.

Get Started

New Client Form

Please complete this form completely and accurately so that we can get to know you and your pet(s) before your visit. If this is an emergency or your pet requires immediate attention, please call us at (330) 239-1271 for a faster response.

Name *

First

Last

Spouse/Alternate Contact Name *

First

Last

Address *

Address Line 1

City

State

Zip Code

Primary Phone *

Secondary Phone

Email address *

Referred by

Web
Location
Personal
Other

Please Specify *

If Other Please Specify *

OK to use photos/pet information for social media purposes?

Pet’s Name *

Species

Canine
Feline

Sex *

Male
Female

Spayed/Neutered? *

Breed *

Color *

Age *

weeks, months, years

Birthdate *

Microchipped? *

What is the microchip ID?

Previous DVM:

Date(s) of last vaccines

Reason for visit:

Medical
Lodging
Grooming

Current concerns/symptoms

Current medications (including flea/tick/heartworm)

I UNDERSTAND AKRON MEDINA VETERINARY HOSPITAL DOES NOT OFFER BILLING (cash/check/credit card)? *

Initial

Ready for a visit?

We want our animal hospital in Medina, OH, to be a welcoming place for people and their pets. We take veterinary medicine to the next level without sacrificing the family feel that is so vital to quality patient care. Being attentive to your pets’ needs and understanding your concerns are extremely important. Request an appointment for your pet using our online system on PetDesk, and keep up with your pet’s health by downloading our app!

Request Appointment Download App

Have Questions?

Complete our online form, and a member of our team will be in touch with you shortly.



Location

686 Medina Road
Medina, OH 44256



Contact Information

P: 330-239-1271
E: akronmedina@yahoo.com



Hours

Mon: 7:30 am – 8:00 pm
Tues – Fri: 7:30 am – 5:00 pm
Sat: 8:30 am – 12:00 pm
Sun: 9:00 am – 12:00 pm (lodgers only)

Name *

First

Last

Email *

Phone

How can we help you? *