(864) 963-2704
staff@cedarlakeanimalhospital.com
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Home
About Us
Services
Resources
Online Pharmacy
Contact
Request Appointment

New Client Form

Save time during your first appointment! Complete your required new client form online before your appointment.

a vet holding a cat

New Client Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

Registration

Owner *

First

Last

Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Cell/Other *

Main Phone *

Work Phone *

Spouse Cell *

Spouse/Sig. Other Name

Email *

Emergency Contact Name *

Phone

How did you learn of our clinic? *

Yellow Pages
Sign
Recommendation
Other

If recommended, by whom? *

Other (specify) *

Number of Pets *

Reason for Visit *

Pet Information

Name of Pet *

Species (dog, cat, other.) *

Breed *

Sex *

Male
Neutered Male
Female
Spayed Female

Date of Birth *

Vaccination History (Date and type of last vaccinations) *

Pet’s Current Medications *

Pet’s Diet *

Authorization

I hereby authorize the veterinarian to examine, prescribe for, or treat the above described pet. I assume the responsibility for all charges incurred in the care of this animal. I also understand that these charges will be paid at the time of release and that a deposit may be required for surgical treatment.

Signature of owner *

Clear Signature

Date *

Method of Payment *

Cash
Mastercard
Visa
American Express
Discover

Phone

Ready to Visit?

We proudly serve the pets of Simpsonville and the surrounding areas. We look forward to seeing you and your pet! Click the button below to book an appointment.

Request Appointment Download App

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Location

682 Fairview Road
Simpsonville, SC 29680

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Contact Information

Email: staff@cedarlakeanimalhospital.com
Phone: (864) 963-2704

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Hours

Mon – Fri: 7:30 AM – 5:30 PM
Sat – Sun: Closed

Have a Question?

Feel free to reach out! Once you’ve completed the form, a member of our team will be in touch with you.

Name *

First

Last

Email *

Phone

How can we help you? *

Name

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