Thank you for entrusting us with your pets’ care. At Lone Tree Animal Care we are dedicated to providing the highest level of veterinary medicine along with friendly, compassionate service. Please complete the form below so we can accurately record information about you and your pets.

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Name

This field is for validation purposes and should be left unchanged.

Thank you for entrusting us with your pets' care. At Lone Tree Animal Care, we provide the highest level of veterinary medicine along with friendly, compassionate service. Please complete the form below so we can accurately record information about you and your pets.

Name

First Last

Client D.O.B. (to dispense controlled substances)

Cellphone

Home Phone

Driver License

Address

Street Address City State / Province / Region ZIP / Postal Code

How you heard about us?

Pet Insurance

Policy #

Pet Name #1

Species

Sex

Spayed/Neutered

D.O.B

Breed

Color

Pet Name #2

Species

Sex

Spayed/Neutered

D.O.B

Breed

Color

Pet Name #3

Species

Sex

Spayed/Neutered

D.O.B

Breed

Color

If your pet has been seen at any other hospital, please list here:

I authorize Lone Tree Animal Care to use photos of my pet for social media and advertising (initials)

I authorize Lone Tree Animal Care to share my pets' medical records if they are requested by other hospitals or facilities (initials)

I understand that i must pay for services rendered at the time of discharge (initials)

I understand that the state of California requires my pet to have a current Rabies vaccine; Lone Tree Animal Care reserves the right to require one be given before treatment is administered (initials)

I understand that Lone Tree Animal Care is not a 24-hour facility and does not provide overnight care. (initials)

Signature*

Date*

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