Welcome to Lyndale Animal Hospital!

We are very pleased to have you as a client. We realize that there are several great veterinary hospitals to choose from, and we will do all we can to serve you and your pet.

Our online forms are provided for your convenience. If you are a new client, our new client form will help you get started prior to your appointment (so you do not have to keep your pet waiting).
 

To make your visit a pleasant experience, here are some tips to assist you.

• Call for an appointment. Our phone number is (612)) 872-4674.
   
• Arrive 5-10 minutes early. This will give our receptionist time to verify your information in the computer and get you into an exam room.
   
• If your pet has received medical care at another hospital, please have the previous veterinarian fax a copy of his or her medical records to us so that we may review them in advance. Our fax number is (612) 872-7813.
   
• If possible, please fill out the Patient/Client Information Form, listed below, in advance. You can bring it in with you at the time of your first appointment.

Welcome to our Clinic

Client Information

Last Name: ______________________________ First Name: _______________________

Spouse, Roommate, Significant Other: __________________________________________

Street Address: ____________________ City: ________________ Zip Code: __________

Home Phone: ____________ Cell Phone: ____________ Add’l Number(s): ____________­__

Occupation or Title: ______________ Work Phone: ____________ Email: ______________

Emergency Contact Name: ­­­­___________________________________ Phone: __________

How did you hear about our practice? __________________________________________

Primary reason for visit? ___________________________________________________

Pet Information

Pet’s Name: _________________________________ Dog   Cat  Other____________

Sex:  M  F   Age: ______ Birthdate: _______________ Breed: ___________________

Color: ________________ Neutered/Spayed:  Yes   No  At what age? ______________

Authorization

I hereby authorize the veterinarian to examine, prescribe for, or treat the above-described pet(s). I assume responsibility for all charges incurred in the care of the animal. I also understand that all professional fees are to be paid at the time services are rendered.

Please circle your method of payment:          Cash          Check          Visa          Master Card

Signature of Owner: __________________________________Date: _______________