3333 W. County Rd. 54G P.O. Box 527 Laporte, CO 80535

Online Forms Medication Refills

Home
New Clients
About
Dogs
Cats
Exotics
Horse Care
Contact
- Appointments
- Hours & Location
More
Shop

New Client/Owner Form

Name
Spouse
Mailing Address AND Street Address
City
Zip Code
MAIN CONTACT NUMBER
Work/Home/Cell
Is it OK to contact you via text
- Yes
- No
Number to text:
Email address
Would you like to receive reminders for annual physicals, vaccines, etc. by
- Mail
- Email
- Mail and Email
Would you like to receive our informational newsletter by email?
- Yes
- No
Place of employment
Children-if still at home (names/ages)
Driver License Number (State)(If writing check)
Preferred method of payment
- cash
- Check
- credit card
- Care Credit
Do you have pet insurance?
- Yes
- No
Company?
Are you eligible for senior discount? (over age 65)
- Yes
- No
How did you hear about us? Please help us to know the most effective way to reach out to new clients. If a friend who is a client referred you, they will receive a coupon for $20 off services at their next visit.
Please Specify
The following statements must be signed in acknowledgment of hospital policies.
- Full payment is expected at the time of service unless prior written arrangements with the doctor have been made.
- Any returned checks are subject to a service charge of $35 and any additional processing fees.
- There is a $5.00 per month billing charge and 1.5% accrued finance charge for any unpaid balances over 30 days. Any accounts overdue by more than 60 days will be DOUBLED and turned over to a collection agency or pursued legally. Any costs involved with collection of an overdue account, together with attorney’s fees, will be added to the overdue balance.

Request Your Appointment Today!

(970) 490-1999 (Text or call)

Like us on Facebook

Appointments

We will do our best to accommodate your schedule

Request Appointment

Get In Touch

(970) 490-1999 (Text or call)

info@laporteanimalclinic.com

3333 W. County Rd. 54G P.O. Box 527 Laporte, CO 80535

2025 © Laporte Animal Clinic | Sitemap | Accessibility | Website by DOCTOR Multimedia

Accessibility by WAH

PHONES NOT WORKING

ATTENTION: OUR PHONES ARE NOT ABLE TO ACCEPT VOICEMAILS RIGHT NOW. IF YOU DON’T GET THROUGH, WE ARE PROBABLY ON THE LINE. YOU CAN TRY AGAIN LATER, OR PLEASE EMAIL US AT INFO@LAPORTEANIMALCLINIC.COM OR TEXT US AT 970-578-3649. WE ARE SORRY FOR ANY INCONVENIENCE.

Call Us Text Us