West Lynn Animal Clinic

709 West Lynn
Austin, TX 78703

(512)482-8600

westlynnvet.com

New Client Check In

If you would like to make an appointment, you can assist us to expedite your check in by submitting this form.

Thank you for your cooperation in letting us assist you.

New Client

Owner Name (required)
First Name (required)
Last Name (required)
Co-Owner Name
First Name
Last Name
Address (required)
Street Address (required)
City (required)
,
State / Province (required)
Zip / Postal Code (required)
Daytime Phone (required)
Phone TypePhone Number (required)
Co-Owner Phone
Phone TypePhone Number
Evening Phone (required)
Phone TypePhone Number (required)
E-Mail Address :
How were you referred to our clinic? If referred by a friend, please include their name! (required)

Pet's Name (required)

Age: Years, Months

Type of Pet (required) :
Breed:

Color:

Sex: (required)
Male
Female


Neutered/Spayed
Neutered
Spayed


Are your pets vaccines current?
Do you have pets medical records?
Medical records at another veterinary Practice?
Yes
No


Name of Former Veterinary Practice

May we request a transfer of records?
Yes
No


Do you already have an appointment scheduled with us?
If so, when is your appointment scheduled?

Special requests or conditions?

Please list any additional pets here

Please Read
I understand, by indicating I agree and submitting this registration, that I am responsible for any charges incurred by my pet while in the care of the doctors at West Lynn Veterinary Clinic and that charges are due and payable at the time of service, unless other arrangements are made in advance. Any balance that is carried over a period of 30 days will accrue a monthly finance charge of 1.5% or 18% per annum. Any balance that I leave unpaid will be forwarded to West Lynn Veterinary Clinic's collection agency, and will incur a 25% collection fee for which I am liable, in addition to monthly finance charges.
I have read this statement and -
I Agree
I Disagree


Name
First Name
Last Name

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