New Patient Form - Anderson Lakes Animal Hospital

*We use peanut butter and other various treats for positive reinforcement during visits. Does anyone in your home have food allergies that we should be aware of? Please list them here

*We use a communication software called PetDesk to manage client communications, send you reminders about upcoming appointments and to send you offers about our products and services. You agree that we may share your name, pet's name, email address, address and phone number with PetDesk to facilitate this process. You will receive a welcome email within 24 hours. You may elect to OPT out of any reminder services at that time.

How do you prefer us to contact you regarding your pet(s)’ health?

Call Primary/Cell Text Primary/Cell Email

How did you hear about our clinic?

Word of Mouth: Is there an individual we may thank?

Internet: Which site?

Humane Society or Rescue Organization

Previous/Current Client

Microchip/Tattoo ID Number

Did you bring records today from your previous veterinarian?

Picture Release: I understand and approve that Anderson Lakes Animal Hospital may take pictures during the course of my visit for use on their website and/or social media.
Anderson Lakes Animal Hospital may use pictures of clients/patients for promotional and publicity purposes without liability or obligations to the participants.

Please opt me out of picture participation

By checking the boxes below, I agree that I have read and acknowledged each statement as it is written.

Anderson Lakes Animal Hospital will gladly prepare a written treatment plan with fees associated with the doctors plans for care. Please ask the Technician or Doctor to provide a plan before treatments. PAYMENT IS DUE IN FULL AT THE TIME OF SERVICE(S) RENDERED.

Anderson Lakes Animal Hospital accepts payment in the form(s) of cash, check*, Visa, Mastercard, and Discover. *A $25.00 fee will be levied for any check that is returned due to insufficient funds or for any other reason. An alternative payment method to satisfy the account balance and this fee will be required immediately.

New Patient Registration Form

Please complete this form with your and your pet's basic information so that we may effectively and efficiently provide the service you deserve!