Available Appointments
*
Name of Pet
*
Reason for Appointment
*
Your Name
*
First Name
Last Name
Phone Number
*
Are you a current client with Lakehouse Vet?
*
Yes
No
Email
example@example.com
Address
*
Street Address
Street Address Line 2
City
State
Zip Code
How would you like to be contacted? (By clicking the boxes below, you are agreeing to be contacted by Lakehouse Vet via the preference selected. Message and data rates may apply. Message frequency varies. You can always "opt-out" or change your preferences by contacting Lakehouse Vet.)
Texting is okay
Emailing is okay
Only call me, do not text or email me
How did you hear about us?
Google
Facebook
Instagram
FAST Frederick Swim Team Ad
Nextdoor
A friend/word of mouth
Other
Your Pet's Details
Have we seen this pet before?
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Yes
No
Species
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Please Select
Dog
Cat
Rabbit
Ferret
Guinea Pig
Rat
Bearded Dragon
Other
Breed
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Sex
*
Please Select
Male, neutered
Male, intact
Female, spayed
Female, neutered
Unknown
Age
*
Estimated Weight
*
Previous Medical History/Records
*
I will provide my own records (please email at least 48 hours in advance of appointment)
Lakehouse Vet may contact my previous vet(s) for records
There are no previous records (or it's been several years since the last vet visit)
Other
Previous Vet Hospital Name(s) and Info
Authorization and Terms
*
By checking this box, I am confirming that all information provided herewith is accurate to the best of my knowledge. I am the owner of the animal(s) listed herein and authorized to make all medical and financial decisions related to said animal(s). I hereby authorize Lakehouse Veterinary LLC and all doctors, staff, and team members of the veterinary practice to examine, prescribe, and treat my pets under a valid Veterinary-Client-Patient Relationship, which can be terminated by either party for any reason. Lakehouse Veterinary strives to be transparent with any charges and is always happy to discuss and review estimates and treatment plans. I assume full responsibility for all charges incurred for the care of my pets and understand any fees charged are due at time of service. I also understand that Lakehouse Veterinary reserves the right to obtain deposits for appointments, surgical treatments or hospitalization.
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