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:

If your dog wears a shock or electronic collar, we kindly ask that you do not shock, stim, or utilize these collars in any way while inside our facility. Our ultimate goal is to make veterinary visits as positive as possible and by adhering to this rule, you help us create a calm and comfortable environment for your companion animal.

Preferred Location *

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