New Client Registration Form

We know that finding the best care for your pet is important to you. At Sand Lake Animal Clinic, we do our best to make the choice clear. By providing above the industry standard in both our treatments and facilities, we ensure that every pet is provided with the most comprehensive and compassionate care possible.

We are an American Animal Hospital Association accredited animal clinic, and are dedicated to providing the highest caliber service at all times.

Owner Information

All fields marked with an * are required fields

First Name*
Middle Initial
Last Name*
Address*
City*
State*
Zip Code*
Home Phone
Work Phone  
Cell Phone  
Email*
Spouse Name
Spouse Cell
Referred By

Pet Information

First Pet's Name*
Breed*
Species DogCatOther
If other
Sex
Color
Birth Date

Second Pet's Name
Breed
Species DogCatOther
If other
Sex
Color
Birth Date

 

Payment is Due at Time of Services

Payment methods accepted: Cash, Credit Card, Check with proper identification.

Authorization to perform services I, the undersigned owner or authorized agent of the above admitted patient(s), hereby authorize the doctors and staff of Sand Lake Animal Clinic to administer such treatment as is necessary and to perform procedures therapeutically and/or diagnostically. I further understand that no guarantee of successful treatment is made.

Payment for outpatient services is due the day they are rendered. If your pet is here for surgery, hospitalization, or boarding, a deposit may be required and the balance will be due when your pet goes home.

Financial Responsibility Agreement: I understand that I am responsible for all charges for the care of my pet(s) provided by Sand Lake Animal Clinic. Unpaid balances over 30 days are subject to a monthly 1.5% finance charge. I understand that if any unpaid balance is assigned to a third party collection agency for collection or placed with an attorney to obtain judgement or otherwise satisfy payment of my account, a collection fee of 33 1/3 % will be added to my account. I agree to pay that fee. I further agree to pay reasonable attorney fees, court cost, interest, late fees and the like. I understand and agree to the above terms.