Lake Mills Veterinary Clinic / New Client

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New Client Check-In

You can speed up the check-in process by either completing the online form below, which will be sent to our office automatically when you finish it, or you can download our client registration form, print it, fill it out at home and bring it with you at the time of your visit.

You can find a map and directions to our location here.

As a new client, establishing the doctor patient relationship is a critical part of providing the best care for your pet. This first appointment, depending on your pet's health and the services required, should take approximately 40 minutes.

Please plan to bring in a fresh fecal (stool) sample. You should collect this no more 12 hours before your visit. Samples should be about the size of a golf ball and free of yard waste or other contaminants. You can collect the sample by turning a small plastic bag inside out and using it as a 'glove' to collect the fresh specimen. Samples which have been frozen or otherwise exposed to extreme temperatures will not be viable.

Please understand that we can not prescribe for or provide diagnoses over the phone for animals that our doctors have not seen - no exceptions.

Form - New Client Registration Form

Owner's Name & Email (required)
First Name (required)	Last Name (required)

Spouse/Co-owner
First Name	Last Name

Address (required)
Street Address (required)


City (required)	State/Province (required)	Zip/Postal Code (required)
,

Cell-Phone
Phone Type	Phone Number

Daytime Phone (required)
Phone Type	Phone Number (required)

Evening Phone (required)
Phone Type	Phone Number (required)

E-Mail Address (required) :

In Case of EMERGENCY contact (person + phone) (required)

PET INFORMATION

Pet's Name (required)

Age: Years, Months (or date of birth)

Type of Pet (required) :

Breed & color:

Sex: (required)
Male
Female

Neutered/Spayed
Neutered
Spayed

Are your pets vaccines current?

Do you have your pet's medical records?

Medical records at another veterinary Practice?
Yes
No

Name of Former Veterinary Practice

May we request a transfer of records?
Yes
No

Would you like us to call you for your appointment

Reasons or conditions that prompted your visit?

Special requests or conditions?

Please list any additional pets here

Do you have a large animal (farm) account with us?

Please Read
I hereby authorize the veterinarian to examine, prescribe for, or treat my pets. I assume responsibility for all charges incurred in the care of these animals. I also understand that these charges will be paid at the time of service and that a deposit may be required for hospitalization or surgical procedures.

I have read this statement and -
I Agree
I Disagree

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Lake Mills Veterinary Clinic
W7797 Hwy V
Lake Mills, WI 53551
phone (920) 648-2421 or (800) 524-4363
fax (920) 648-8284

http://www.evetsites.com