Owner's First/Last Name *

First

Last

Owner's Date of Birth *

Spouse or Authorized User

First

Last

Would you like to add your spouse or another authorized user? By adding authorized users, you are allowing access to your account information, your pet(s) information, authorize any services needed, able to drop off/pick up your pet, and pick up medication. If you have more than one authorized user, let us know at check-in and we can add them to your account!

Address *

Address Line 1

Address Line 2

City

State

Zip Code

What's the best number to reach you at? *

Spouse/Other Number

Is there a secondary number we can contact if needed? Want to add more numbers? Let us know at Reception!

What is your email? *

This is a perfect way for us to send you reminders and promotions!

What is your preferred method of contact?

Call
Text
Email
Other

Let us know which way is the best way to reach you.

Now, tell us about your pet!

We can't wait to meet them!

Pet's Name *

Pet's Date of Birth *

Don't know? Take a guess. We'll help you figure it out!

What kind of pet do you have? *

We love them all!

What breed is your pet? *

Is your pet male or female? *

Is your pet spayed or neutered? *

Yes
No

Tip: Neutering is for males, spaying is for females.

What color is your pet? *

Any identifying markings?

Any allergies or chronic conditions? *

Does your pet have Pet Insurance? *

Yes
No

If yes, please provide us with a blank claim form upon arrival.

If you answered 'Yes' to having Pet Insurance, what is the name of the insurance company? *

Some popular ones are Trupanion, Embrace, Nationwide, Healthy Paws, etc.

Who is your pet's previous veterinarian? *

If none, you can skip this! If your pet has seen more than one veterinarian, please list all vets and their City/State.

Is there anything else we should know about your pet so we can make sure to provide them with the best possible care? *

Do you have any other pets?

Yes
No

Do you have any other pets?

Yes
No

Lakeside Animal Hospital - Pet/Payment Policy

If you are dropping off your pet for any reason, all patients must be current on vaccines. All dogs must have a current Rabies vaccine, fecal, Distemper/Adenovirus/Parainfluenza/Parvo, and a Leptospirosis vaccine given within the past year, and a Bordetella vaccine given within the past six months. All cats must have a current Rabies vaccine, Feline Rhinotracheitis/Calici/Panleukopenia/Chlamydia vaccine, triple test, and a fecal within the past year. If any internal and/or external parasites are found, your pet will be treated at your expense.

ALL FEES ARE DUE AT THE TIME OF SERVICE!
We accept cash, debit, and all major credit cards. We will gladly accept Care Credit in ANY amount. We ONLY offer 6 months no interest for amounts of $200 or more. We also accept Scratchpay. We DO NOT accept checks! An estimate for care will be provided for all emergencies, hospitalizations, surgeries, in any cases that require extensive treatment, or upon request. A deposit prior to treatment may be required and is at the hospital's discretion.

NO SHOW/LATE CANCELLATION POLICY:
We understand that circumstances happen but request that if this is the case you please contact us with at least 24 hours advance notice to cancel your pet’s appointment. By doing so you free a space for another pet in need of care. Clients who miss an appointment without 24 hours advance notice will be considered a “no show” and will be subject to a No Show Fee added to the cost of their next appointment or, alternatively, will forfeit their deposit for their pet(s) visit if a deposit/credit has been applied to their account. If an appointment falls on a Monday or day after holiday, a message left via voicemail, text, or PetDesk App will qualify as adequate notice.

This policy has been established to provide the highest level of veterinary care to our patients. We do understand that emergencies arise and that it may not be possible to give such a notice. Exceptions to the No-Show/Late Cancellation Policy will be determined by management. Thank you for your cooperation.

PRESCRIPTION POLICY
Lakeside Animal Hospital has an on-site pharmacy and can dispense most medications for your pet. If you elect to use an outside pharmacy for your prescription medications or if a medication is not carried in our pharmacy, a written prescription will be provided for you upon request. If you choose to use an outside pharmacy to obtain your pet's medications, you will be required to sign a responsibility and liability waiver, before a prescription can be written.

BOARDING POLICY
Any boarding in conjunction with a surgery or dental will include an additional fee of $5/night for each night of post-operative care. We require a signed estimate and full pre-payment of any surgical or dental procedure to be performed during the boarding reservation. If a surgery or dental is scheduled during boarding and the patient is sharing kennels with another pet, they will be separated into two kennels post surgery.

We require a deposit for any holiday boarding or any boarding reservations longer than (1) week at the time of booking. If the boarding reservation is cancelled within 48 hours of the reservation date, the deposit is non-refundable.

Lakeside Animal Hospital - Pet/Payment Policy *

I have read the above and agree to the Pet/Payment Policy.

We love taking pictures! Do we have your permission to photograph your pet(s) during their visit and use it on our social media platforms (Facebook, Website, etc)?

Yes
No

Upload

Click or drag a file to this area to upload.

If you have your pet's medical records, please attach them here!

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New Client Form

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Lakeside Animal Hospital - Pet/Payment Policy

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