Skip to content

Home
Contact

Login

Existing Client Log In: Email: Password:

First Time Login?
Forgot Password?

Veterinarians Lapeer | Animal Medical Center Lapeer

Contact Us

Phone: 810-664-6524
Fax: 810-664-6574
animalmedicalctr@hotmail.com

Search Lifelearn: Search Site:

New Clients
About Us
Pet Services
My Pet
Pet Health
Links
VetSource Online Store

New Client Registration Form

Home » New Clients » New Client Registration Form

Thank you for considering our hospital as your pet’s provider of veterinary services. We are dedicated to maintaining the health of your pet and look forward to many future years together.

Please complete this form as fully as possible prior to your first appointment which will help expedite the registration process and give us valuable insight in providing optimal care for your pet(s). The required sections have a red * asterisk.

Owner's Name
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Day-Time Phone*
Evening Phone
Mobile Phone
Email*
Enter Email Confirm Email
Co-owner's Name & Contact #
Name
First Last
Phone
How did you find out about our practice?
- Clinic Location
- Personal Referral
- Internet Search / Website
- Yellow Pages
- Clinic Sign
- Newspaper / Print Media
- Other
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
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

In this section

Make an Appointment
New Client Registration Form
Take A Tour
What To Expect

Our Services

We provide a wide variety of services and advice to assist you and your pet.

In the News

Cats in the Car – Trips to the Veterinarian
May 17, 2018
Getting your cat to your veterinarian may seem like an impossible task – how does…
Stop the Spray- Keeping Skunks at Bay
May 10, 2018
Spring has sprung, and the critters that have been sleepily overwintering have begun…
It’s National Pet Week!
May 3, 2018
National Pet Week has been celebrated during the first week of May for over 35 years.…

RSS

Contact
Contact
About
About
Privacy
Privacy
Sitemap
Sitemap

© Copyright 2018 ePet Websites | Powered by WebDVM