Your Name *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Cell Phone *

Preferred contact number? Or alternate Phone

Employer

E-Mail Address *

Driver’s License

State

Spouse or other contact name *

Clients relationship to other contact *

Cell Phone *

Your Pet’s Name

Does your pet have health insurance?

Yes
No

Date of Birth or Age

Gender

Male
Female

Is your pet Spayed/ Neutered?

Yes
No

Which veterinary office has most recently seen your pet? *

Why did you choose Lawrence Veterinary Hospital? *

Other

Referred by

Internet Search

(Facebook, Google etc)

Financial Policy

Thank you for choosing Lawrence Veterinary Hospital. Our primary mission is to deliver the best and most comprehensive veterinary care available for your pet. An important part of the mission is making the cost of optimal care as easy and manageable for our clients as possible by offering several payment options. Lawrence Veterinary Hospital requires payment in full at the time of service.

For some treatments, surgeries, or hospitalized care, a deposit may be required. Should that be the case, you will be informed at the time an estimate is provided to you. The remaining balance will be due at the time of your pet’s discharge from the hospital.

We require payment at time of service. We accept cash, checks with valid ID, Visa, Mastercard, Discover, American Express and Care Credit. By signing below, I agree to these terms.

Signature of guardian/agent presenting this pet for treatment:

Clear Signature

I authorize Lawrence Veterinary Hospital to post pictures of my pet on the hospital’s website, Facebook and Instagram pages for marketing and educational purposes unless specifically declined by me in writing. *We will not post pictures with client faces/other identifying features unless provided additional written consent. We respect your right to privacy.

New Client Registration Form

New Client Registration Form

Click here for PDF form download

Financial Policy

We proudly serve the pets of Lawrence, KS, and beyond.

Location

Contact Information

Hours