New Client Registration Form

New Client Registration Form

We thank you for the opportunity to care for your pet family member! Please complete the form below to set up an account.
Primary Owner*

First NameLast Name
Primary Owner Pronouns
Secondary Owner

First NameLast Name
Secondary Owner Pronouns
The Primary Pet Owner listed above is the only person who con legally remove the Secondary Owner from this account or change any ownership information. Any changes must be requested in writing.
Primary Owner Cell*
Please enter a valid phone number.
Secondary Owner Cell
Please enter a valid phone number.
Primary Number (the first number we call)*
Please enter a valid phone number.
We are required to report the Primary Owner's Date of Birth to the DEA in the event that your pet is prescribed a controlled substance.
Primary Owner's DOB (MMDDYYYY)*
Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Primary Owner's Email*
example@example.com
Secondary Owner's Email
example@example.com
Emergency Contact/Authorized Agent(s): *only list people you outhorize to make medical decisions for your pet(s) on your behalf to be contacted in the event that you or the secondary owner on the account are unreachable You may also list pet sitters or dog walkers here.
1. Authorized Agent Name
Phone Number
2. Authorized Agent Name
Phone Number
How did you hear about us?
Patient Information
Pet's Name*
Species*
Breed*
(Cats: Breed Specific or Domestic Shorthair, Domestic Mediumhair, Domestic Longhair)
Sex*
Color/Markings*
Date of Birth or Estimated Age*

MonthDayYear
Date
Do you have pet insurance for your pet?*

YesNo
What company?
Policy#
Please list ALL previous veterinary facilities (including emergency and/or specialty) where your pet has been seen. It is important that our doctors have time to review all medical history before the appointment. Please reach out to ALL previous veterinary facilities and request your pet(s) records be sent to us via email at info@grandlakevet.com. If your pet has not been seen anywhere before, please write N/A.
Previous Vet #1 (General Practice or ER)*
Phone Number*
Please enter a valid phone number.
City and State of Previous Vet*
Previous Vet #2 (General Practice or ER)*
Phone Number*
Please enter a valid phone number.
City and State of Previous Vet*
Already have records? Upload them here!

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PHOTO CONSENT

We love social media! Do we have your permission to share your pet's image and story on social media, our website, and other forms of related media?

Your name and personal information will never be shared.
Photo Consent?*
We are unable to extend credit. We accept cash, personal checks, credit cards, Scratch Pay and Care Credit. We will gladly prepare a written estimate upon request.

The undersigned hereby acknowledges that they are entering into an agreement with The Grand Lake Veterinary Hospital for veterinary services. I hereby authorize the veterinarian(s) to examine, prescribe for, or treat the above pet. assume responsibility for all charges incurred in the care of my pet and I understand that all fees are due at the time services are rendered.
Client signature*

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In order to schedule an appointment, we require an $82.00 deposit that will be applied to your pet's first visit.

Once we receive your completed registration form, we will call you at your Primary number to collect the deposit and schedule your appointment!

Pick days and times that work best for you, and we'll do our best to find the earliest availability!*

The Grand Lake Veterinary Hospital & Client Agreement

Be the people our dog or cat thinks we are!
One of the core values of The Grand Lake Veterinary Hospital and all of our carefully chosen staff is to treat ALL of our clients AND their furry family with the same care and compassion we would expect for ourselves and our own pets. We strive to be a bright spot in your day!

Our ENTIRE team is here to HELP YOU and your furry family. We know your time is valuable; however, we are a hospital and sick patients are unpredictable. The sick patient that delays your appointment, prescription pick-up, or check out today might be your pet tomorrow! By signing this agreement you acknowledge that you will bring your best human self when you interact with our staff.

By choosing GLVH you are choosing:
- An independently owned practice that prides itself on individualized non packaged care
- To work with 8 collaborative doctors who not only have a top notch education, but also have between 1- 3.5 decades of experience
- Medical care choices driven by research to recommend the best products and lab work, not the ones a corporate owner negotiated for the most profit
- A practice that takes the time to explain your pet's conditions and help you understand how to best take care of your furry family
- Caring and respectful team members
- Live humans that pick up the phone
- An emphasis on low stress handling of pets so they enjoy coming to see us
- Upfront and transparent explanations and estimates for recommended care
- Wellness and preventative care-to avoid illness and help pets live longer
- A hospital that still provides Urgent care when you need us most!
By signing this agreement you acknowledge that we are NOT the no frills, low cost, get in and get out veterinary hospital for everyone, but you chose us and promise to show kindness and respect to all of our staff.*

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Date*

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Date
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New Client Registration Form

Patient Information

The Grand Lake Veterinary Hospital & Client Agreement