Veterinary New Patient Registration Form

  • New Patient Registration Form

    Thank you for considering Lake Meridian Animal Hospital, for your pet's medical needs. Please fill out our new client/patient registration form in it's entirety to ensure we can provide you and your pet with the best possible care.
  • Have you ever brought a pet to Lake Meridian Animal Hospital, previously Value Pet Clinic Kent before?*
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  • Is There a Spouse/Partner/Family Member Who Should Be Listed On Your Account?*
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  • In case of emergency

  • Is there anyone else (besides above listed contacts) who should be listed on your account, who has ongoing permission to make medical decisions for your pet(s)?
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  • How did you hear about us?*

  • Pet's Information

    Pet 1
  • Species*
  • Sex*
  • Spayed or Neutered?*
  • Pet's Birthday
     - -
  • Does your pet have a microchip?*
  • Additional pets?*

  • Additional Pet's Information

    Pet 2
  • Species*
  • Sex*
  • Spayed or Neutered?*
  • Pet's Birthday
     - -
  • Does your pet have a microchip?*
  • Additional pets?*

  • Additional Pet's Information

    Pet 3
  • Species*
  • Sex*
  • Spayed or Neutered?*
  • Pet's Birthday
     - -
  • Does your pet have a microchip?*
  • Additional pets?*

  • Additional Pet's Information

    Pet 4
  • Species*
  • Sex*
  • Spayed or Neutered?*
  • Pet's Birthday
     - -
  • Does your pet have a microchip?*

  • Client Policies and Procedures

    We want you to be aware of and understand the following policies and procedures for all clients.
  • We Love Social Media! Do we have your permission to post pictures of your pet(s), you and your pet(s) and/or your pet(s) and our team on Facebook, Instagram, Twitter, www.Lakemeridiananimalhospital.com and any other marketing and/or other social media outlets we may choose to use?*
  • Lake Meridian Animal Hospital uses email, text and our own hospital app for communications regarding our patient's reminders for health care needs. Do we have your permission to contact you via email, text and/or our app regarding these reminders?*

  • FINANCIAL POLICY Our office accepts Visa, Mastercard, Discover, American Express and cash. We do not accept checks.  In addition, we also offer several 3rd party financing options for our clients via Care Credit and Scratchpay. We accept a variety of Care Credit plans based on the total transaction amount for your pet. Care Credit requires that payment only be made for services as they are rendered, we cannot charge services to your account in advance. Therefore, Care Credit cannot be used for PAW plan services. Additionally, the use of Care Credit requires that the card be present every time and that two forms of identification are verified. We appreciate your understanding of our desire to protect your account/identity. As financing options are offered, we cannot offer additional in-house payment plans for our services. Clients needing additional financial support are encouraged to apply for Care Credit with a co-signer. Full payment is due at the time of service. This includes any charges/fees agreed to by my authorized proxy. Our team is happy to provide any client with a written treatment plan prior to services being rendered. The client will be responsible for a 1.5% monthly finance charge on accounts over 30 days and any collection and/or legal fees on accounts over 90 days. Your signature below indicates your agreement with these policies.

  • TREATMENT CONSENT: By signing this document, I declare I am the lawful owner of all listed pets and all information is true and correct to the best of my knowledge. I hereby authorize the veterinarian(s) of Lake Meridian Animal Hospital to examine, prescribe for, or treat my pet(s) to the best of their abilities. I assume responsibility for all charges incurred in the care of this animal. I acknowledge that medical information will not be released to anyone not indicated on this form without my express verbal and/or written permission with the exception of another veterinary facility.
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