New Client Registration + Appt. Check-In

New Client Registration + Appt. Check-In
Please fill out all of your contact information, and as much information as you can for your pet (minimum of name and species required). Please note that by providing your email address and cell phone number you authorize Lifetime Pet Centers to send vaccination reminders, appointment reminders, newsletters, and online pharmacy information to you. You may opt out of any individual reminder services in the welcome emails you will receive.

Want access to your pets' medical records, vaccine reminders, online pharmacy orders, and 24/7 online scheduling? Download our app by clicking this link! Be sure to use the same email you provide to us in the form below and once your information is loaded into our practice management software you will be able to sign up. It can take up to 24 hours for your pet's information to appear once you verify your email.
Primary Owner:*
Primary Phone Number (Cell Preferred)*

Area CodePhone Number
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Secondary Owner:

First NameLast Name
Secondary Phone Number:

Area CodePhone Number
Email*
This email will be the only address on your account. You will use this address in order to access our app. Search for "LifetimePet" in the App Store or Play Store. Once you verify the address on your account with us you will have access to your pets' health records, vaccines, ability to order food and medications, and our loyalty program.
How did you first hear of us?*

Phone BookLocationGoogleYahooFacebookWebsiteClient ReferralOther
If a current client referred you, please list their name here. (They receive loyalty rewards for referrals as a thank you!)
What is your preferred method of contact?

Phone CallText MessageEmailNo Preference
Pet's Name*
Species*

CatDog
Gender*

Intact MaleNeutered MaleIntact FemaleSpayed Female
Is this pet covered by pet health insurance?*

YesNo
Breed
Description (Color, markings, coat length, etc.)
Approximate Birthday*

MonthDayYear
Date
Identification

MicrochipTattooBothOther
Upload a photo of your pet for their medical record!

Browse Files

Cancelof
Previous/Current medical records or other information:

Browse Files

Cancelof
Authorization: I hereby authorize the veterinarian to examine, prescribe for, or treat, the above described pet(s). I assume responsibility for all charges incurred in the care of this animal. I also understand that payment is due at the time of release and that a deposit may be required for surgery and/or hospitalization.*

Clear
Below you will fill out some information for your pet's upcoming appointment. Please be as detailed as possible. This will allow us to complete your check-in prior to your arrival to the hospital. You may also leave a preferred contact number specifically for today's appointment if it is different from the primary number listed above. Please let a staff member know if you have any other questions or concerns for your pet's appointment. We look forward to meeting you!
Best Phone Number for your Appointment

Area CodePhone Number
Date of Appointment*

MonthDayYear
Date
Name of Person Presenting Patient*

First NameLast Name
What is your pet being seen for during their appointment?*

Wellness Appointment with Dr. MillerSick/Injured Appointment with Dr. MillerMedical Progress/ Recheck with Dr. MillerTechnician Appointment or Diagnostics (Bloodwork, X-rays)GroomingOther
What current diet is your pet eating?*
Please include the brand, life stage, and amount you are feeding daily.
Is your pet allergic to anything?*

YesNo
If your pet is allergic to anything please list below:
Food, medications, anesthesia, previous reactions to vaccines, etc.
Please list all medications and supplements your pet is currently taking below. Include dosage, frequency, and the last time each medication was given. Be sure to include all preventative medications as well (flea/tick/heartworm/intestinal parasites, etc.).*
Has your pet shown any of the follow symptoms recently? (Check all that apply)*

VomitingDiarrheaNot EatingEating More/ Very HungryNot Drinking WaterDrinking More Water than UsualSneezingCoughingDischarge from Eyes/NoseLimping and/or PainfulItching and/or ChewingRed/Inflamed Skin/SoresShaking Head/ Scratching at EarsDifficulty Breathing and/or CoughingLethargic/ Sleeping MoreActing Off/ No Specific SymptomsHere for Recheck- Symptoms have ImprovedHere for Recheck- Symptoms have NOT ImprovedHere for Wellness- No Problems or ConcernsOther
Please include any additional information you would like Dr. Miller and our staff to know prior to your pet's appointment. We all look forward to meeting you and providing care for your pet!
Should be Empty: