30266 Old Hwy 371 | Pequot Lakes, MN 56472
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Welcome to our hospital, Thank you for giving us the opportunity to care for your pet(s). So that we may become better acquainted, please complete the following form.
Note * indicates a required field.
Spouse's name if applicable:
Suite, Unit, Apt:
Email Address: *
Main Phone: *
Place of Employment:
Are you a seasonal resident?*
Reminder Preference: *
ALL FEES ARE DUE AT THE TIME SERVICES ARE RENDERED
Preferred Payment Method:
Visa / Matercard
How did you become aware of our clinic?
If other in previous please specify:
Personal Recommendation (whom may we thank):
Is there a veterinary clinic/hospital we can contact for previous vaccine or medical records? *
Previous Veterinary Clinic/Hospital Name: *
List any previous serious illness or surgeries:
Does your pet have any known allergies to vaccinations or medications?
List any allergies if yes to above:
Is your pet on any special diet or medications?
List any diet or medications if yes to above:
Yes, I am interested in alternative medicine
No, I prefer to treat my pet with traditional medicine
I have no preference, please treat my pet with whatever therapy is necessary
1st Pet's Name: *
Birth Date: *
What sex is this pet? *
Has this pet been spayed/neutered? *
Date of rabies vaccine:
Date of distemper vaccine:
Date of lyme vaccine (dog):
Date of bordetella vaccine (dog):
Date of leukemia vaccine (cat):
2nd Pet's Name:
What sex is this pet?
Has this pet been spayed/neutered?
3rd Pet's Name:
Tender Loving Healthcare
for Your Loved One
Pequot Lakes Animal Hospital,
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