New Client Form

DUE TO AN INCREASE IN NO SHOW APPOINTMENTS, WE NOW REQUIRE A ONE TIME $50 DEPOSIT AT THE TIME OF SCHEDULING FOR ALL NEW CLIENTS. THE DEPOSIT WILL BE APPLIED TOWARD YOUR FIRST VISIT.

*PLEASE NOTE: NEW CLIENT APPOINTMENTS ARE SCHEDULING 4-5 WEEKS OUT AT THIS TIME*

Tell us about yourself and your pet!

* Indicates required field

Client Name *

First

Last

Addition name(s) on account *

Address/Street Name *

City/Zip Code *

Cell Phone Number(s) & Name(s) *

Email *

Pet(s) Name *

Pet(s) Birthday *

Breed/Color *

Sex/Spay/Neutered *

Previous Veterinary clinic *

please upload previous records if available *

Max file size: 20MB

WOULD YOU LIKE TO RECEIVE EMAIL OR TEXT REMINDERS OR BOTH? *

PICTURE OF YOUR PET *

Max file size: 20MB

Additional information *

I give the Lakeview Animal Hospital the right to use my testimonial (and/or photo) provided for reproduction in any medium including but not limited to; website, video, broadcast, print, and electronic means for purposes of advertising, trade, display, exhibition or editorial use. Further, you also (i) agree to release Lakeview Animal Hospital from all claims for libel, slander, invasion of privacy, infringement of copyright or right of publicity or any other claim and (ii) confirm that you are over the age of 18 years old. *

Yes, you have my permission to use images of my pet No, please don't post pictures of my pet.

Thank you for taking the time to fill out the information!
We look forward to meeting you and caring for your furry friend!

Submit

*Our staff will reach out to you within 24 hours of submitting form.

Hours of Operation

Monday 8am - 7pm
Tuesday 8am - 6pm
Wednesday 8am - 7pm
Thursday 8am - 6 pm
Friday 8am - 6pm
Saturday CLOSED
Sunday CLOSED

Payment Options

Apply for CareCredit

Apply for Scratchpay

Contact Us

8818 Portage Road
Portage, MI 49002

Phone: (269) 323-3434
Fax: (269) 323-2556

[email protected]