New Veterinary Client Registration Form

New to Lake Animal Hospital? We’re so excited to meet you and your pet! Fill out the form below to get started!

Owner's Name(Required)

Owner's First Name Owner's Last Name

Co-Owner's Name

Co-Owner's First Name Co-Owner's Last Name

Address(Required)

Street Address Address Line 2 City State ZIP Code

Owner Cell Phone(Required)

Co-Owner Cell Phone

May we contact you by text?

Yes

Email(Required)

Where have your pets had prior veterinary care?

Please contact your previous clinic to have your pet’s medical records emailed to us at records@lakeanimalhospital.com or faxed to (651)426-8882.

Pet #1

Pet Name(Required)

Species(Required)

Breed(Required)

Sex(Required)

Spayed or Neutered(Required)

Yes

Color(Required)

Birthdate(Required)

Pet #2

Pet Name

Species

Breed

Sex

Spayed or Neutered

Yes

Color

Birthdate

Treatment Authorization

I hereby authorize the veterinarians and staff of Lake Animal Hospital to exam, complete diagnostics, perform procedures, prescribe, and administer treatment as is considered medically necessary for my pet(s).

Record Release Authorization

I give Lake Animal Hospital permission to obtain my pet’s medical records from previous veterinary clinics. I also consent to the release of my pet(s)' medical information including vaccine history, medical records, diagnostic images, and lab work to other veterinary hospitals, boarding facilities, authorities, and pet insurance companies as necessary.

Payment Policy

I understand that full payment is due at the time of service. Our office accepts Visa, MasterCard, Discover, American Express, along with cash and checks. Clients with payment concerns are asked to speak to a Client Service Representative prior to services being rendered. Payment plans are available through third party provides Care Credit and Scratch Pay. No other payment plans are offered at this time.

Your signature below indicates you have read and understand these policies.

Signature(Required)

Date(Required)

If you do not hear from us withing the next business day, please call us at (651) 426-1381 or email info@lakeanimalhospital.com to follow-up on your request.

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Phone

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651-426-1381