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New Patient Form

If this is your first time visiting Smithfield Road Veterinary Hospital please complete our New Patient Form using anyone one of the methods below.

Option 1

Complete Online

You can fill out and submit our New Patient Form below, in advance online.

Option 2

Fill out Upon Arrival

If you rather, you can fill out the form when you arrive at our hospital.

New Patient Form

Owner Information

Emergency Contact

Patient Information

Primary Veterinarian Information

Please fill this section in if we are not your primary care veterinary hospital. By listing your primary care veterinarian, you are authorizing Smithfield Road Veterinary Hospital, PLLC to release patient information to the primary care hospital or veterinarian.
By submitting this form, I hereby authorize Smithfield Road Veterinary Hospital, PLLC to render medical care for my pet(s) as deemed necessary by the veterinarian. I understand that no guarantee can be given to the outcome of treatments and take it as my responsibility to comprehend any risks involved. I agree to pay for the cost of all services to which I consent to by written or verbal estimate. I understand that a deposit is required before diagnostics and treatments can be initiated and that payment in full is required prior to discharge of patient from Smithfield Road Veterinary Hospital, PLLC.

New Patients Are Welcome

Smithfield Road Veterinary Hospital, PLLC is currently accepting new patients! Our experienced and kind vets are passionate about the health of Knightdale pets. Contact us today to book your furry friend's first appointment.

Contact Us

(919) 679-0170 Contact