Name: Lake Country Veterinary Care
Address: 2527 Cherry Valley Turnpike, Marcellus, NY, 13108, United States
Telephone: 315-673-4858
Price range: $

Welcome to Lake Country Veterinary Care! Thank you for entrusting us with the care of your furry family member. Whether you are a new or existing client, we want to make sure we have your current contact information so we are able to communicate efficiently and better serve you.

You may contact our office by phone at 315-673-4858 or via email at [email protected].

Date of your Scheduled Exam

At this time Lake Country is operating curbside. As a result, we will have you wait outside in your vehicle while your patient is taken inside the building for examination. Depending on the weather, the doctor will either come outside to discuss his/her findings or they will call you from inside the building to discuss. Please provide the number you wish us to use on the day of your appointment. Provide us with better history with your patient and give us more time during the appointment to physically examine your pet.

Name *

First

Last

Email *

Primary Phone *

Secondary Phone

Driver's License Number *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Preferred Method of Contact *

Email
Text

What is your preferred method for account reminders? *

Email
Phone
Postal Mail

Employer

First

Last

Employer Phone

Spouse/co-owner/family member you would like listed on your account

First

Last

Spouse/co-owner/family member Phone

I give consent to release information to the individual(s) listed above. *

Consent
Decline
Not Applicable (N/A)

How did you find out about our clinic? If you were referred by someone, who should we thank? *

Social Media

I hereby give Lake Country Veterinary Care permission to take photographs and videos of me and/or my pet for the purpose of posting on LCVC social media accounts - Facebook, YouTube, Twitter, Instagram, and clinic website. * *

Consent
Decline

Financial Policy

I am the person responsible for the animals brought in for care at Lake Country Veterinary Care. I understand that payment must be made in full at time of services. I also understand that if payment is not made, I will be liable for all finance charges applied to my account. I recognize that a deposit may be required before surgical treatment of my pet. In the event of default where it becomes necessary to place this account in the hands of a third party for collection, I understand and agree to pay all costs of collection, including reasonable attorney's fees and court costs. *

I have read and understood the statement above
Other

Please explain: *

Lake Country accepts cash, check, Discover, Visa, Mastercard, Amex, Scratch Pay and Care Credit for payment

Signature *

Date *

Client Information Form