WELCOME TO
Lake Area Animal Clinic
Client Information:
Authorization:
I hereby authorize the veterinarian to examine, prescribe for, or treat my pet. I assume responsibility for all charges incurred in the care of the animal. I also understand that all professional FEES ARE DUE AT THE TIME SERVICES are rendered.
Pet Health History:Pet #1
Pet Name: type here Birth Date:
Breed: Color
Sex: Make Neutered Female Spayed
Current medications your pet is taking:
Prior Illnesses/Surgeries:
Primary reason for visit:
Did you adopt this pet from Christ-Yoder Animal Shelter? Yes No