New Client Form

LAKES VETERINARY HOSPITAL

Home
Hours
Veterinary Care
New Client Form
Lakes Veterinary Hospital On Line Pharmacy
Canine Acres
Humane Society Otter Tail County
Pet Poison Helpline
New and Current Client Center
Additional Links
LVH Employees Only

New Client Form

* Indicates required field

Client Name *

First

Last

Fill our your first and last name.

Address *

Spouse/Other *

First

Last

Fill out first and last name of spouse/other.

Cell Phone Number *

Home Phone Number *

City *

State *

Zip Code *

Email *

May we e-mail you with reminders for your pet? *

How did you find us *

Friend (Whom may we thank?) *

First

Last

If a friend referred you to this clinic please put down his/her name so we may thank them.

Are you past/present Military? *

Yes No

If yes, we are happy to offer 10% discount with proof of service. Example: VA card, VFW card, Service Papers etc.

Reason for visit? *

Pet's Name *

Pet's Name

Age or Birth Date *

Enter your pet's approximate age or birth date.

Species *

Sex *

Breed *

What breed is your pet?

Declawed: *

Yes No

For cats. Is he/she declawed.

Vaccination History (Date and Type of Last Vaccinations). If unsure of Vaccination History, please list past Veterinary Clinic(s)/Hospital(s). : *

If you have records please bring them with you to your appointment.

May we contact the Veterinary Clinic you listed for records? *

Yes No

Upload any Vaccination Records or bring them with you to your appointment *

Max file size: 20MB

Please check any symptoms or problems that you have noticed about your pet: *

Bad Breath Behavior Problems Loss of Balance Scooting Scratching Shaking Head Eye Problem

Choose Any *

Not Eating Limping Weakness Coughing Diarrhea Sneezing Seizures Thirst and/or Increased Urination Vomiting

Choose Any *

Difficulty Breathing Sudden Weight Change Seems Depressed Gagging

Other Symptoms, please explain: *

Current Medication(s); and describe your pet's diet (Brand of food, treats, table food, etc.): *

Authorization
I hereby authorize the Veterinarian to examine, prescribe for, or treat the above described pet. I assume responsibility for all charges incurred in the care of this animal. I understand that these charges MUST BE PAID AT THE TIME OF RELEASE and that a deposit may be required for surgical treatment.

Signature of Owner/Agent: *

Date: *

Method of Payment *

Cash Care Credit Visa MasterCard Discover Check

Submit

Office Hours

Monday: 8 am - 5 pm
Tuesday: 8 am - 5 pm
Wednesday: 8 am - 5 pm
Thursday: 8 am - 5 pm
Friday: 8 am - 5 pm
Saturday: 8 am - Noon
Sunday: Closed

Contact Us

Phone: 218-864-5695
Fax: 218-864-5155
Email: lvhbattlelake@gmail.com

Click HERE to enter our on line pharmacy

602 S Olaf Ave, Battle Lake, MN 56515