Haven Lake Animal Hospital

300 Milford Harrington Highway
Milford, DE 19963

(302)422-8100

www.havenlakeanimalhospital.com


Client Information Form

Please provide your contact and pet information so that we may better serve you and your family. 

Thank you for your cooperation in letting us assist you.

Client Contact Information

Name (required)
First Name (required)
Last Name (required)
Address (required)
Street Address (required)
City (required)
,		State / Province (required)
Zip / Postal Code (required)
Daytime Phone (required)
Phone TypePhone Number (required)
Evening Phone (required)
Phone TypePhone Number (required)
E-Mail Address :
Pet's Name (required)

Age: Years, Months

Type of Pet (required) :
Breed:

Sex: (required)

Male
Female


Neutered/Spayed

Neutered
Spayed


Are your pets vaccines current?
Do you have pets medical records?
Medical records at another veterinary Practice?

Yes
No


Name of Former Veterinary Practice

May we request a transfer of records?

Yes
No


Would you like us to call you for your appointment
Reasons or conditions that prompted your visit?

Special requests or conditions?


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At Haven Lake Animal Hospital, we understand that you may feel a bit overwhelmed by it all, but rest assured that we are here to help and guide you and your pet through the process and back to health. If your pet has not recently been in for an annual wellness exam or dental exam, is not current on his or her vaccinations, or has any other issues you are concerned about, please contact us to schedule an appointment.

 

Contact Us Button Emergencies Button Appointments Button Rehabilitation Button Prescriptions Button

At Haven Lake Animal Hospital, we understand that you may feel a bit overwhelmed by it all, but rest assured that we are here to help and guide you and your pet through the process and back to health. If your pet has not recently been in for an annual wellness exam or dental exam, is not current on his or her vaccinations, or has any other issues you are concerned about, please contact us to schedule an appointment.

 

Contact Us Button Emergencies Button Appointments Button Rehabilitation Button Prescriptions Button