Thorpe Animal Hospital

396 Lake Nepessing Rd
Lapeer, MI 48446

(810)664-2233

www.thorpevet.com

Thank you for giving us the opportunity to care for your pet. We’ll be happy to answer any questions you have about your pet’s health. To ensure the best care possible, please take the time to fill in this form completely. Thank you.

Welcome Form

Owner's Name (required)

Spouse/Other

Address (required)
Street Address (required)
City (required)
,		State / Province (required)
Zip / Postal Code (required)
House Phone

Work Phone

Cell Phone

Thorpe Animal Hospital may release the below number if my pet is found (required)
Home
Work
Cell
E-Mail Address (required) :
Driver's License Number (The state of Michigan requires a client’s drivers license number if a Schedule II medication is prescribed for your pet)

Date Of Birth :
Employer's Name and Address

In case of emergency, please call: (required)

Reason for visit (required)

Would you prefer email vaccine/appointment reminders? (required)

Do you have pets medical records?

Yes
No


Name of former Veterinary Practice

May we request transfer of records

Yes
No


Pet Health History
Pet's Name (required)

DOB (required)

Weight (required)

Type of Animal (required)
Canine
Feline
Other
Male or Female (required)
Male
Female
Spayed or Neutered (required)
Yes
No
Breed (required)

Color (required)

Vaccination history (date/type of last vaccines) (required)

List any medications that your pet is currently on

2nd Pet's Name

DOB

Weight

Type of Animal
Canine
Feline
Other
Male or Female
Male
Female
Spayed or Neutered
Yes
No
Breed

Color

Vaccination history (date/type of last vaccines)

List any medications that your pet is currently on

Do you have pet insurance? (required)

Do you have a policy or claim number?

Photo Release
Photos may be taken of your pet for identification purposes and kept on record for reference. Often, we need reference photos and we prefer to draw from our patient base. These photos may be used on our social media platforms to depict a certain breed or just for a fun reference. We will never release these photos for use outside of our practice. The following will grant or deny us permission to photograph your pet (s) without obligation of financial reimbursement.
Select one: (required)
Yes, I grant to Thorpe Animal Hospital, its representatives and employees the right to take photographs of my pet(s) in connection with the above-identified subject. I authorize Thorpe Animal Hospital, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that Thorpe Animal Hospital Hospital may use such photographs of my pet(s) without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.
No, I decline to have Thorpe Animal Hospital use or publish photographs of my pet(s) for any reason.
Please agree before submitting
I (Being of 18 years of age) hereby authorize the veterinarian to examine, prescribe for or treat the above described pet. I assume responsibility for all charges incurred in the care of this animal. I understand that these charges MUST BE PAID AT THE TIME OF RELEASE AND THAT A DEPOSIT MAY BE REQUIRED FOR HOSPITALIZATION.
Select one: (required)
Agree
Disagree

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