New Client Check In

If you would like to make an appointment, you can assist us to expedite your check in by submitting this form. If you prefer, you may also print this form here: New Client Form and bring it in to our clinic.

Thank you for choosing LGVC and your cooporation in letting us assist you.  We look forward to being your veterinary practice!

Form - New Client

Name & Email (required)
First Name (required)
Last Name (required)
Address (required)
Street Address (required)
City (required)
State/Province (required)
Zip/Postal Code (required)
,
Daytime Phone (required)
Phone TypePhone Number (required)
Evening Phone (required)
Phone TypePhone Number (required)
E-Mail Address :
Pet's Name (required)

Age: Years, Months

Type of Pet (required) :
Breed:

Sex: (required)
Male
Female

Neutered/Spayed
Neutered
Spayed

Are your pets vaccines current?
Do you have pets medical records?
Medical records at another veterinary Practice?
Yes
No

Name of Former Veterinary Practice

May we request a transfer of records?
Yes
No

Would you like us to call you for your appointment
How did you choose our clinic?

Special requests or conditions?

Please list any additional pets here

Please Read
Payment is due at the time of service. We accept cash, checks that are electronically converted, Visa, Master Card, Discover and Care Credit. I understand that if payment becomes past due, billing fees and the maximum allowable interest rate will be charged. I understand further that I am responsible to pay for services rendered, including reasonable attorney’s fees and costs of collection in the event of default.
I have read this statement and -
I Agree
I Disagree


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