New Client Form

Welcome to Lane Veterinary!

Thank you for considering Lane Veterinary for your pet's needs. Please fill out our new client/patient registration form in entirety to ensure we can provide you and your pet with the best possible care.

IMPORTANT:

We are a Fear Free certified practice. This helps your pet receive the best possible care in a safe and stress-free environment. We hope you an enjoy a stronger bond as a result too! Please fill out the the end of the form to the best of your ability we can meet your pet's needs.

Have you ever brought a pet to Lane Veterinary before?

Yes

Owner's Name *

Owner's Name

First

Last

Email *

Main Contact Number *

Secondary Contact Number

Address *

Address

City

State/Province

Zip/Postal

How Would You Prefer To Be Contacted? *

Phone (Main Number)

Phone (Secondary Number)

Text (Main Number)

Text (Secondary Number)

Is There a Spouse/Partner/Family Member Who Should Be Listed On Your Account? *

Yes

Section

Spouse/Partner/Family Member Name

First

Last

Please tell us how the above person is related to you so we can refer to your relationship appropriately.

Spouse/Partner/Family Member Contact Number

Is there anyone else (besides above listed contacts) who should be listed on your account, who has ongoing permission to make medical decisions for your pet(s)? *

Yes