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Make an Appointment 570-769-6088

Tour Our Facility Online Pharmacy

Make an Appointment 570-769-6088

Make an Appointment 570-769-6088

Make an Appointment 570-769-6088

Tour Our Facility Online Pharmacy

Make an Appointment 570-769-6088

Make an Appointment 570-769-6088

Make an Appointment

570-769-6088

New Client Form

This lets us record our pet and owners into our management software so that we can effectively and efficiently provide the service you deserve!

Download & Print Form

NEW CLIENT/NEW INFO FORM
Date*
MM slash DD slash YYYY
Thank You for giving us the opportunity to care for your pet(s).

So that we may become better acquainted, please complete the following:
The following to be completed by persons over the age of 18.
Client Information
Owner's Name*
First Last
Spouse's Name
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Primary Phone*
*
- Cell
- Home
Contact Name:*
Alternate Phone
- Cell
- Home
Contact Name:
Work Phone
Ext:
Place of Employment*
Driver's License #*
State*
Email*
ALL FEES ARE DUE AT THE TIME SERVICES ARE RENDERED
Please indicate choice of payment.*
- Cash
- Major Credit Cards
- Care Credit
How did you become aware of our clinic?*
- Drove By
- Yellow Pages
- Google
- Our Website
- Facebook/Social Media
- Personal Recommendation
Personal Recommendation
Patient Information
Pet's Name*
Dog or Cat*
Breed*
Date of Birth/Age*
Color*
Sex*
Spayed or Neutered*
Any previous serious illnesses or surgeries?*
Any allergies to vaccinations or medications?*
Vaccination History*
- Yes Vaccinated
- Never Vaccinated
- Unknown
List Vaccinations*
Add a second pet?*
- Yes
- No
Pet's Name*
Dog or Cat?*
Breed*
Date of Birth/Age*
Color*
Sex*
Spayed or Neutered*
Any previous serious illnesses or surgeries?*
Any allergies to vaccinations or medications?*
Vaccination History*
- Yes Vaccinated
- Never Vaccinated
- Unknown
List Vaccinations*
Add a third pet?*
- Yes
- No
Pet's Name*
Dog or Cat*
Breed*
Date of Birth/Age*
Color*
Sex*
Spayed or Neutered?*
Any previous serious illnesses or surgeries?*
Any allergies to vaccinations or medications?*
Vaccination History*
- Yes Vaccinated
- Never Vaccinated
- Unknown
List Vaccination*
Add a fourth pet?*
- Yes
- No
Pet's Name*
Dog or Cat*
Breed*
Date of Birth/Age*
Color*
Sex*
Spayed or Neutered*
Any previous serious illnesses or surgeries?*
Any allergies to vaccinations or medications?*
Vaccination History*
- Yes Vaccinations
- Never Vaccinated
- Unknown
List Vaccinations*
Previous Veterinarian
We appreciate the opportunity to treat and care for your pet for the first time. In order to provide your pet with the best possible care, we may contact your previous veterinarian for your pet’s past medical records.
Previous Veterinarian/Hospital Name
Phone
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Make an Appointment Online Pharmacy Contact Us

Business Hours

Monday

7:00am-6:30pm

Tuesday

7:00am-5:00pm

Wednesday

7:00am-6:30pm

Thursday

7:00am-6:30pm

Friday

7:00am-6:30pm

Saturday

8:00am-11:30am

Sunday

Closed

CALL 570-769-6088

2161 Woodward Ave.
Lock Haven, PA 17745

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Email Address

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