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New Client/Patient Form

We will do our utmost to provide your pet(s) with the best possible care. Please feel free to contact our office at (219) 319-0679 regarding the health and well-being of your pet(s)

Pet Information

Pet 1

Pet Name
Pet's Date of Birth

For Referrals/Emergency clinic patients only:

Client Name
Doctor Name

Owner Information (No Minor Children)

Owner Name(s)

First Name
Last Name
Spouse First Name
Spouse Last Name

Owner Contact Information

Street Address
Primary Phone
Secondary Phone
Email Address

How Did You Learn of our Clinic?

Payment Policy

Payment is due in full at the time of each visit.
We accept cash, check, VISA, MasterCard, Discover, American Express, debit cards, Care Credit and money orders.


If you have any questions about the New Client/Patient Form give us a call at (219) 319-0679 and we’ll be happy to assist you.

Plan Ahead for Your Visit

Save time by filling out our New Client/Patient Form and get directions to our office.