Name *

First

Last

Email *

Primary Phone *

Secondary Phone

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Who else is authorized to make decisions about your pet's healthcare? *

First

Last

Phone

How did you find out about our hospital? If you were referred by someone, who should we thank? *

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Color *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

Previous Veterinarian/Hospital *

Do you have a second pet? *

Yes
No

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Color *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

Previous Veterinarian/Hospital *

Do you have a third pet? *

Yes
No

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Color *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

Previous Veterinarian/Hospital *

Do you have a fourth pet? *

Yes
No

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Color *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

Previous Veterinarian/Hospital *

Do you have a fifth pet? *

Yes
No

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Color *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

Previous Veterinarian/Hospital *

We love to share photos of our wonderful patients, do we have permission to take a photo of your pet(s) for social media? *

Yes
No

Payment is due at the time services are rendered. We accept cash, checks (with identification), all major credit cards, and Care Credit. A deposit may be required for surgical procedures and hospitalization. Past due accounts are subject to late fees and those turned over to collection are subject to collection and/or legal fees. *

I have read and accept the financial policy.

We require 24-hour notice for all cancellations or reschedules, if you cancel or reschedule without a 24-hour notice or no-show for your appointment, a deposit will be required to reschedule, and a no-show fee will be applied. If you no-show 3 times then you will be required to drop your pet(s) off for services. *

I have read and accept the no show/cancellation policy.

I hereby authorize the veterinarians and staff at Lago Vista Animal Clinic to examine, prescribe, and/or treat the above-described pet(s). I consent to receiving communications from Lago Vista Animal Clinic by email, phone, and text message. *

I have read and consent.

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