New Client FormLake Area Animal Clinic Save time during your next appointment! Complete your required forms online from any device at any time before your visit. Get Started New Client Form Please enable JavaScript in your browser to complete this form.Client Information:Name *FirstLastEmail *Home Phone *Work PhoneDriver's License Number: *MUST SHOW PROOF OF A VALID DRIVER'S LICENSE UPON ARRIVALAddress *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeIs your residential address the same as your mailing address? *YesNoMailing Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeHow will you be paying your bill today? *CashCheckVisaMastercardDiscoverI hear by authorize the veterinarian to examine, prescribe for, or treat my pet. I assume responsibility for all charges incurred in the care of the animal. I also understand that all professional FEES ARE DUE AT THE TIMESERVICES are rendered.Signature *Clear SignatureSignature of responsible partyDate *Pet Health History: Pet # 1Pet Name *Birth Date or Age *Sex *FemaleFemale SpayedMaleMale NeuteredBreedColorCurrent Medications your pet is takingPrior Illnesses/SurgeriesPrimary reason for visitDid you adopt this pet from the Hill Country Human Society? *YesNoAdd an additonal pet information? *YesNoPet Health History: Pet # 2Pet Name *Birth Date or Age *Sex *FemaleFemale SpayedMaleMale NeuteredBreedColorCurrent Medications your pet is takingPrior Illnesses/SurgeriesPrimary reason for visitDid you adopt this pet from the Hill Country Human Society? *YesNoAdd an additonal pet information? *YesNoPet Health History: Pet # 3Pet Name *Birth Date or Age *Sex *FemaleFemale SpayedMaleMale NeuteredBreedColorCurrent Medications your pet is takingPrior Illnesses/SurgeriesPrimary reason for visitDid you adopt this pet from the Hill Country Human Society? *YesNoAdd an additonal pet information? *YesNoPet Health History: Pet # 4Pet Name *Birth Date or Age *Sex *FemaleFemale SpayedMaleMale NeuteredBreedColorCurrent Medications your pet is takingPrior Illnesses/SurgeriesPrimary reason for visitDid you adopt this pet from the Hill Country Human Society? *YesNoSubmit
