Name *

First

Last

Email *

Primary Phone *

I consent to receive SMS text messages from Grass Lake Animal Hospital. Msg & data rates may apply. Reply STOP to opt-out. *

Yes
No

Secondary Phone

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Who else is authorized to make decisions about your pet's healthcare? *

First

Last

Phone

How did you find out about our hospital? If you were referred by someone, who should we thank? *

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Color *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

Grass Lake Animal Hospital requires previous records for efficiency and accuracy. Please indicate which applies to your pet: *

My pet has not been to a vet in over 5 years, they have no previous records
I will bring a copy of my pet’s most recent medical records with me to the appointment
I will email previous records for my pet to grasslakeanimalhospital@gmail.com prior to my scheduled appointment
I would like Grass Lake Animal Hospital to reach out to my previous vet(s). My pet has been a patient of the following hospitals in the past 5 years:

Previous vet(s) information *

I understand that failure to provide previous records for my appointment may cause a delay in care. *

I have read and understand.

Payment is due in full at the time that services are performed. If being admitted into the hospital, we cannot begin the care of your Pet until you have confirmed your desire to do so by 1) signing the client consent & estimate form, and 2) leaving an initial deposit of 50% of the upper end of the estimate. This is the only way that we have of knowing for certain that you want us to proceed with the care of your Pet. We accept Cash, Visa, MasterCard, Discover, and CareCredit payments. We neither extend credit, nor bill for services. All open invoices are sent to collections after 45 days unless prior arrangements are made. *

I have read and accept the financial policy.

New Client Form

Grass Lake Animal Hospital Veterinary New Client Form

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Location

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Hours