Country Doctor Veterinary Hospital

6807 Weiss Road
New Tripoli, PA 18066


*Last Name
*First Name
*Zip Code
Email Address
*Primary Phone Number
Secondary Phone Number
Place of Employment
Work Phone Number
Spouse's Phone Number
Spouse's Place of Employment
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How did you become aware of our clinic?
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Please list if you are interested in any additional information about Boarding, Obedience Training, Home-Again Microchip, Care Credit, Pet Insurance, or Lifetime License.

All fees are due at the time services are rendered. We accept the following payment forms: Cash/Check, Visa, MasterCard, Discover, Care Credit
Please list owners or authorized agents of your pets and note if they have the authority to make medical decisions for your pets and/or may access your pets medical information.

Any person given the right to make medical decisions will be financially responsible for the requested treatment.

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