Thank you for giving us the opportunity to care for your pet. We would like to become better acquainted, so please complete the following information.

Owner *

Mailing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Primary Number *

Email Address *

How did you hear about us? *

Is there another veterinary clinic your pet has records located? If so, please let us know where so we can contact them.

Do you allow your pet’s photos to be used for social media and marketing purposes? *

Yes
No

If you chose yes, email us your favorite picture of your pet to hello@westlafayettevet.com so we can update their profile picture in our system.

purposes? Neutered/Spayed pet

Pet’s Name *

Breed/Mix *

Color/Markings *

DOB/Age *

Male/Female *

Neutered/Spayed *

Add an additional pet?

Yes
No

Pet’s Name *

Breed/Mix *

Color/Markings *

DOB/Age *

Male/Female *

Neutered/Spayed *

West Lafayette Veterinary New Client Form

New Client Form

Location

Contact Information

Practice Hours

Urgent Care Hours