New Client Form – Veterinarians in Lambertville, MI

Owner's Name

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Preferred Contact #*

Contact # Type*

Mobile
Home
Work

Email*

Enter Email Confirm Email

PROFESSIONAL FEES ARE TO BE PAID AT THE TIME SERVICES ARE PERFORMED*

In admitting my pet(s) for diagnostics, treatment, or surgery, I authorize the veterinarians of Lambertville Veterinary Clinic, and their support staff, to administer such treatment and/or perform such diagnostic or surgical procedures as deemed necessary.

It is understood that an estimate of charges will be given for services. No guarantee or assurance can be made as to the results that may be obtained.

I assume full financial responsibility for all charges incurred by my pet. I realize that these charges may exceed a given estimate if complications arise. I understand that I will be contacted prior to treatment, if possible, should complications occur.

In the even that you are no longer available for your appointment, please provide 24 hours notice. We understand that emergencies happen. We do not charge a fee for a first time no-shows or late cancellations. After a second no-show or late cancellation, you will be required to prepay or leave a deposit for all future appointments.

I agree to the above Fees policy.

Co-owner's Name & Contact #

Name

First Last

Preferred Contact #

How did you find out about our practice?

If Other, please specify:

If Personal Referral, is there someone we can thank for this referral?

Please use this area to give us any other relevant information about yourself or your family

Pet Information

Pet's Name*

Species*

or if other species

Breed (if known)

Color

Date of Birth or Age (if known)

Special Identification (tattoo, microchip, etc.)

Sex

Previous Veterinary Practice (if any)

Previous Veterinarian (if any)

Date of last vaccines (if known)

What vaccines were given at this time

Is your pet on any medication or supplement?

Yes
No

If Yes, please list the medication or supplement

What food does your pet eat?

Does your pet have allergies or drug reactions?

Yes
No

Does your pet have allergies or drug reactions?

Yes
No

If Yes, please list the allergies and reactions

Are there any current or past medical conditions of which we should be aware?

Yes
No

If Yes, please comment on the condition(s) and indicate if they are current or past conditions

Please use the following box to give us any other relevant information about your pet

I give Lambertville Veterinary Clinic permission to take pictures of my pet and use for their social media platforms. Examples are Facebook, Instagram.

Yes
No

PROFESSIONAL FEES ARE TO BE PAID AT THE TIME SERVICES ARE PERFORMED

New Client Registration Form

Owner's Name

Co-owner's Name & Contact #

Pet Information

Location

Hours of Operation

About Us

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