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New Client Application Form

We are currently accepting new clients on a limited basis

Please understand we are currently a one Doctor practice with a full client base.  Due to the recent unforeseen closure of another local Veterinarian, we are inundated with new client requests and are doing our best to accommodate those in the most immediate need of medical care.

We are taking applications and creating a wait list at this time.  In the meantime, we suggest seeking your immediate pets medical needs in the Bangor area.

Thank you for considering our hospital as your pet’s provider of veterinary services. We are dedicated to maintaining the health of your pet and look forward to many future years together.

Please complete this form as fully as possible prior to help expedite the application process and give us valuable insight in providing optimal care for your pet(s). The required sections have a red * asterisk.

Please also provide medical records after you submit your application to clientservices@ellsworthfamilyvet.com

  • Owner's Name

  • Address & Contact

  • Pet Information

  • Date Format: MM slash DD slash YYYY