New Client Registration

Welcome to Lafayette Veterinary Care Center. So we may provide you with exceptional service, please share information about you and your pet(s).

Client Information

Client Name:

Spouse's Name:


City: State: Zip:

Home Phone:

Mobile Phone:

Alt Phone:

Employment Information

Employer's Name & Telephone:

Spouse's Employer & Telephone:

General Information

Who may we contact in the event of an emergency if you are unavailable?

Name: Phone:


How did you become familiar with our hospital?

Another Client:

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Patient Information

1. Pet's Name:

Age/Birth Date:


Spayed/Neutered: Microchipped:

Species: Breed:

Color: Weight:

2. Pet's Name:

Age/Birth Date:

Sex: Spayed/Neutered: Microchipped:

Species: Breed:

Color: Weight:

If your pet is coming to us from another veterinarian, may we collect previous records?

Previous veterinary care by:

Please enter your initials below to acknowledge your acceptance.

We only send records out of our practice by your direct request following each visit. Without this, we do not send records to your previous or primary veterinarian automatically.

Please be aware that we now offer formal estimates or treatment plans for all services by request. Please ask our staff if you would like to be provided a treatment plan outlining the cost of your pet?s care at any time. A deposit may be required for surgery or hospitalization upon admittance. Full payment is due upon the conclusion of care for each in?patient and out?patient services.  

Please indicate your primary choice of payment:

Valid E-mail Address:

How would you like to receive reminders and health updates from us?


We routinely take pictures of our pet patients for their records and occasionally share these on our company websites. May we share your pets photo in these materials?


Lafayette Veterinary Care Center
Lafayette Veterinary Care Center