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What date is your pet's appointment?

Owner's Name

Cell Phone Number

Email Address

Address

Is there a secondary person you would like to add that can make medical decisions for your pet?

Name of Secondary Person

Phone Number of Secondary Person

Pet's Name

Sex

Male
Female
Male, Neutered
Female, Spayed

Species

Breed

Color

Date of Birth (Approximate date of birth is OK!)

Any know drug allergies?

If yes, please list below.

Notes

BY LAW, ALL PETS ARE REQUIRED TO BE VACCINATED AGAINST RABIES VIRUS. PHYSICAL PROOF OF A RABIES VACCINE IS REQUIRED FOR YOUR PET TO BE HANDLED BY OUR STAFF. IF YOU CANNOT PROVIDE PROOF OF A CURRENT RABIES VACCINE THEN YOUR PET WILL BE VACCINATED AT THE VETERNARIAN'S DISCRETION.

PLEASE BE ADVISED THAT IF YOUR PETS BITES A HUMAN IN OUR FACILITY WE ARE REQUIRED BY TEXAS STATE HEALTH AND SAFETY CODE (CHAPTERS 8-26) TO REPORT THE BITE TO AUTHORITIES

Payment is due in full at the time services are rendered.

How do you wish to pay for your pet's visit today? We do not accept checks from new clients.

Cash
Credit/Debit Card
Care Credit
Scratch Pay

Notes

If you have previous medical records for your pet, please bring them with you to your appointment.

At Lakeside Animal Clinic we treat our patients and their owners like family. We strive to provide the very finest in animal care. Our dedicated staff works diligently to address all your pet needs and your concerns and treat you with the utmost kindness and respect. We ask for the same kindness and understanding from you in return. Lakeside Animal Clinic has a zero-tolerance policy for abusive and/or offensive language or discourteous behavior towards our staff and doctors. By signing below, you agree to act appropriately towards our staff and understand that if you violate this policy you will be asked to seek veterinary care at another clinic that can better suite your needs.

I accept.