Welcome to the Cat Clinic of Lafayette!

We’re so excited to meet you! Please fill out the form below so we can get to know you and your pet before your first visit.

Owner Name *

First

Last

Address

Address Line 1

Address Line 2

City

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Zip Code

Phone *

Email *

Preferred Contact Method *

• Phone
• Email

Pet's Name *

Breed/Hair Length

Color/Markings

Age

Sex

• Male
• Neutered Male
• Female
• Spayed Female

Would you like to add a second pet as a new patient? *

• Yes
• No

Pet's Name

Breed/Hair Length

Color/Markings

Age

Sex

• Male
• Neutered Male
• Female
• Spayed Female

Would you like to add a third pet as a new patient? *

• Yes
• No

Pet's Name

Breed/Hair Length

Color/Markings

Age

Sex

• Male
• Neutered Male
• Female
• Spayed Female

Would you like to add a fourth pet as a new patient? *

• Yes
• No

Pet's Name

Breed/Hair Length

Color/Markings

Age

Sex

• Male
• Neutered Male
• Female
• Spayed Female

Would you like to add a fifth pet as a new patient? *

• Yes
• No

Pet's Name

Breed/Hair Length

Color/Markings

Age

Sex

• Male
• Neutered Male
• Female
• Spayed Female

Would you like to add a sixth pet as a new patient? *

• Yes
• No

Pet's Name

Breed/Hair Length

Color/Markings

Age

Sex

• Male
• Neutered Male
• Female
• Spayed Female

Previous Veterinarian

Permission to contact previous vet for records?

• Yes
• No

Previous Veterinarian Phone

Would you like to schedule an appointment?

• Yes
• No

Please specify which pet the appointment is for

What day would you like to visit our clinic? *

• Monday
• Tuesday
• Thursday
• Friday
• Saturday

Please Note: Our Saturday hours are 7:30 am - 12 pm

What time of the day do you prefer? *

• Morning
• Afternoon
• Evening

What is the reason for your visit? *

Phone

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