HOURS

   Monday - Friday

    9:00 AM - 5:00 PM

   

  

   

  

  

    

   HOURS

   Monday - Friday

    9:00 AM - 5:00 PM

   

  

   

  

  

The WellPet Group PC

766 N. Lee Hwy
Lexington, VA , VA 24450

(540)464-1516

www.thewellpetgroup.com

        

New Client Form

If you are a new client and would like to make an appointment, you can assist us to expedite your check in by submitting this form online. Please fill out one form per pet. Thank you for your cooperation in letting us assist you

 

Our form is also available below in PDF format if you would prefer to fill it out and scan it in to us

NewClient.pdf

New Client Form

Name and Email (required)
First Name (required)
Last Name (required)
Email Address (required) :
Address (required)
Street Address (required)
City (required)
,		State / Province (required)
Zip / Postal Code (required)
Phone Number (required)
Phone TypePhone Number (required)
Pet's Name (required)

Age (required)

Type of Pet (required) :
Breed: (required)

Sex: (required)

Male
Female


Is your pet Spayed/Neutered? (required)

Neutered
Spayed


Are your pets vaccines current?
Do you have your pet's medical records?
Are your pet's previous medical records at another veterinary practice?

Yes
No


Name of Former Veterinary Practice

May we request a transfer of records?

Yes
No


Reasons or conditions that prompted your visit?

Special requests or conditions?


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