East Lansing Veterinary Clinic New Client/Patient Form

Full or Preferred Name (MUST BE 18YRS OR OLDER) *

First NameLast Name

Preferred Pronouns (if applicable)

YesNo

Address*

Street Address

CityState

Zip Code

If your mailing address is different from your street address, please inform the reception staff at the front desk.

Phone Number*

Area CodePhone Number

YesNo

E-mail

example@example.com

Secondary Owner's Name

First NameLast Name

Preferred Pronouns (if applicable)

SpouseSignificant OtherRelativeOther

Secondary Owner's Phone Number

Area CodePhone Number

Secondary Owner's Email

example@example.com

YesNo

How did you hear about us?

Other

Phone CallE-mailTexting

Pet's Name*

Pet's Age*

Pet's Birthdate if known

Date

Species

Other Species Type

Breed*

Sex*

Color/Description*

Does Your Pet Have Any Medical Conditions or Major Surgeries We Should Be Aware Of?

Yes I have Copies- please attach your history below or email separately PRIOR to your appointmentNo Prior HistoryNo, I do not have copies, please call my prior vet for history

Prior History

Browse Files

Please upload files or images of any prior medical or vaccine history for your pet(s). We will need this information prior to your appointment. We will put your pet's photo on their patient charts.

Prior Vet Clinic Name

What is the OWNER NAME at previous clinic?

Vet Phone Number

Area CodePhone Number

Pet's Photo

Browse Files

YesNo

Date And Time Of Confirmed Appointment

DateHourMinutesAM/PM Option

YesNo

Pet's Name*

Pet's Age*

Pet's Birthdate if known

Date

Species*

Other Species Type

Breed*

Sex*

Color/Description*

Does Your Pet Have Any Medical Conditions or Major Surgeries We Should Be Aware Of?

Yes I have Copies- please attach your history below or email separately prior to your appointmentI do not have copies, please call my prior vet for historyNo Prior History

Prior History

Browse Files

Please upload files or images of any prior medical or vaccine history for your pet(s). We will need this information prior to your appointment. We will put your pet's photo on their patient charts.

Prior Vet Clinic Name

Prior Vet Phone Number

Area CodePhone Number

Pet's Photo

Browse Files

YesNo

Pet's Name*

Pet's age*

Pet's Birthdate (if known)

Date

Species*

Other Species Type

Breed*

Sex*

Color/Description*

Does Your Pet Have Any Medical Conditions or Major Surgeries We Should Be Aware Of?

Yes I have Copies- please attach your history below or email separately prior to your appointmentI do not have copies, please call my prior vet for historyNo Prior History

Prior History

Browse Files

Please upload files or images of any prior medical or vaccine history for your pet(s). We will need this information prior to your appointment. We will put your pet's photo on their patient charts.

Prior Vet Clinic

Prior Vet Clinic Phone

Area CodePhone Number

Pet's Photo

Browse Files

Yes!No, please do not post

FINANCIAL POLICY

Our office accepts AMEX, Discover, Google/Apple Pay, Visa, Mastercard, ScratchPay Loans, and CareCredit, along with cash and checks. Full Payment is due at the time of service. Clients with payment concerns are asked to speak to a team member before their exam. We are happy to discuss all charges and provide a written estimate for care prior to services. We offer 6 months, deferred interest financing via CareCredit for clients in need of a credit plan. No other payment plans are offered at this time.

CLINIC POLICIES:

1. Cancellation Policy - We understand that plans can change, and we want to be as accomodating as possible. However, in order to ensure that we can provide the best service to all of our clients, we require a minimum of 24 hours' advance notice for cancellations. If a cancellation is made less than 24 hours before the scheduled appointment, a cancellation fee may be applied per scheduled pet's appointment. This fee must be paid in full prior to any future services or products can be rendered. This policy does not include the New Client Deposit. The New Client Deposits are non-refundable without 24 hours cancellation notice.

2. Prescription Policy - At East Lansing Vet Clinic, our first choice for filling prescriptions is through our in-house pharmacy to ensure the highest quality and efficacy. We also offer a convenient online pharmacy for your pet's medications. If you prefer a third-party pharmacy, we can provide you with a written prescription. If a written prescription is requested outside of an appointment time, we require up to 72 hours notice. It is the owner's responsibility to request a written prescription if desired.

3. Return Policy - Legally we cannot accept any returns on any medication once it leaves our building. We can accept limited returns on Prescription Pet Foods. If your pet has medical issues with prescriptions you have taken home, please contact our office immediately for us to address these with you. It is the owner's responsibility to review invoices and address concerns with a team member prior to leaving.

4. Rabies Policy - At East Lansing Vet Clinic, we prioritize the health and safety of both our patients, our clients, and our staff. All species appropriate pets (dogs, cats, ferrets) must have a current rabies vaccination to receive treatment at our clinic.

Your signature below indicates your agreement with our policies and acceptance of all financial and medical responsibities for above listed pets.

Typed Name As Signature*

New Client/New Patient Form

OWNER INFORMATION

PET INFORMATION

Pet #1

Pet #2

Pet # 3

POLICIES