New Client Form in Windermere, FL | Chain of Lakes Animal Clinic

Date*

Date Format: MM slash DD slash YYYY

Owner

First Last

Phone*

Email

Is it okay if we text your phone?*

Yes
No

Do you prefer communication for follow ups and test results via text, email, or phone call?*

Text
Email
Phone Call

We will always call to discuss significant abnormalities or concerns in your pets health.

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Secondary Owner

Name

First Last

Phone

Emergency

If not different than secondary owner.

Name

First Last

Phone

Pet(s) Information

Pets*

Name	Breed	Color	DOB/Age	Sex + Spayed/Neutered

We love social media! We would love to make your pet a star! Your full name and personal information will never be shared.*

Yes
No

Yes, please make my pet a star!*

Effective 10/11/2021, due to frequent new client cancellations, we now require a $64 deposit per patient for all new client appointments. This deposit is non refundable unless you cancel your appointment at least 48 hours in advance. We appreciate your understanding in allowing us to provide high quality care for your furry family members. Current vaccinations are required by Chain of Lakes Animal Clinic before we may admit any animal for surgery or other procedures. These measures are taken to protect the well-being of all animals within our hospital. For dogs, this includes Rabies and DAPP vaccines. Bordetella and Canine influenza vaccines are strongly recommended but not required. For cats, this includes Rabies and FVRCP vaccines

Signature*