Owner Information

Name *

First

Last

Email *

Primary Phone *

Secondary Phone

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

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

First

Last

Who the contact is ie: friend, partner, spouse etc.

Phone

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

Pet Information

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Previous Veterinary Practice (if any)

Date of last vaccines (if known)

Is your pet on any medications or supplements? *

Yes
No
Unknown

If Yes, please list the medication(s) or supplement(s)

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

Payment is due in full at the time that services are performed. If being admitted into the hospital, we cannot begin the care of your pet until you have confirmed your desire to do so by 1) signing the client consent & estimate form, and 2) leaving an initial deposit of 50% of the upper end of the estimate. This is the only way that we have of knowing for certain that you want us to proceed with the care of your pet. We accept Cash, Visa, MasterCard, American Express, and Debit/Interac payments. All open invoices are sent to collections after 45 days unless prior arrangements are made. *

I have read and accept the financial policy.

I grant permission to Heart Lake Veterinary Hospital, its representatives, and employees the right to take pictures of my pet(s) to use for marketing and promotional purposes. I authorize Heart Lake Veterinary Hospital to copyright, use, and publish these photographs in both print and/or electronically. I agree that Heart Lake Veterinary Hospital may use such photographs of my pets with or without a first name and last initial (i.e.: Fluffy R.) for any lawful purpose including for example such purposes as social media content, publicity, illustration, advertising, and website content. *

Yes
No

New Client Form

Owner Information

Pet Information

Have a Question?

Contact

Location

Opening Hours

After Hours Emergency

OR

Emergency Veterinary Clinic Hwy 10

Hours