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If you are a new client you can fill out and submit the form below to save time during your visit. To expedite the process, please fax or bring any patient history and proof of vaccinations to your first visit.

Call to schedule an appointment today!
Phone: (512) 482-8600

Client Information

If you will have more than one (1) pet with you, please fill out an additional form.

Date of Submission

1) Owner Name

2) Owner Title: Mr. Mrs. Miss. Ms. Dr.

3) Spouse/Co-Owner

4) Street Address

5) City 6) State 7) Zip

8) E-Mail Address 9) Cell Phone #

10) Telephone: Work Home

11) How did you first hear about our clinic?

Street Sign Postcard Web Site Friend

Another Doctor Other

Patient Information

1) Pet Name

2) Date of Birth

3) Species Cat Dog 4) Breed

5) Sex Male Neutered Yes No

Female Spayed Yes No

6) Color

7) Comments
(Example: Medication, Special Diets, Etc.)

8) Previous Vaccination History & Dates
(Example: Rabies - 6/09 , Fel Leukemia - 10/9)

I UNDERSTAND West Lynn Veterinary Clinic will set my pet up in their COMPUTERIZED REMINDER SYSTEM for all necessary EXAMINATIONS and VACCINATIONS. A reminder card is sent at the appropriate time.

(Please make a selection and enter your initials.)
YES, I want my pet’s records included in your reminder system.
NO, I do not want my pet’s records included in your reminder system.

Initials

Payment Policy
All fees and charges are due and payable upon release of patient unless PRIOR arrangements
have been made. Any balance forward is subject to finance charges.
Cash, Check, Visa, Mastercard, American Express accepted.

Signature

(Your typed full name will serve as your signature)