Phone: (219) 879-0249  -  

1943 S Woodland Ave, Michigan City, IN 46360
Mon, Tue, Thu, Fri: 7:30AM-5:00PM
Wed: 7:30AM-7:00PM
Sat: 7:30AM-Noon

Woodland Veterinary Center

Menu
  • Home
  • About Us
    • Our Team
  • New Clients
    • Online Forms
    • Pet Insurance
    • Payment Information
    • FAQ
    • Reviews
    • Pet Health Articles
  • Services
    • AirVet Telemedicine
    • Acupuncture
    • Veterinary Orthopedic Manipulation
    • Veterinary Cold Laser Therapy
    • Dentistry
    • Microchipping
    • Pain Management
    • Radiology
    • Senior Care
    • Ultrasound
    • House Calls
    • Nutritional Counseling
    • Parasite Prevention
    • Surgery
    • Vaccinations
    • Hospice/End of Life Care
    • Pet Wellness Plans
  • Online Store
  • Contact
    • New Prairie Small Animal Clinic
    • Appointments

Client-Patient Information Form

  • Client-Patient Information Form

    Thank you for giving us the opportunity to care for your pet(s). Please help us meet your needs better by taking a few moments to complete each of the information sheets.
  • Date Format: MM slash DD slash YYYY
  • Animal Information/Medical History

  • NameSpeciesBreedColor
  • Age/ DOBSexSpayed/Neutered
  • Prior Illness:Prior surgery not including altering:Date of last Vaccines & Clinic done at:
  • NameSpeciesBreedColor
  • Age/ DOBSexSpayed/Neutered
  • Prior Illness:Prior surgery not including altering:Date of last Vaccines & Clinic done at:
  • NameSpeciesBreedColor
  • Age/ DOBSexSpayed/Neutered
  • Prior Illness:Prior surgery not including altering:Date of last Vaccines & Clinic done at:
  • Notification/ Agreement

    To prevent the spread of infectious diseases and parasites, hospitalized and medical boarded animals must be current on all vaccines and free of internal and external parasites. I authorize the Woodland Veterinary Center to provide vaccines and parasite control as needed for my pet. I am financially responsible for the patient(s) described above and agree to pay all fees incurred. I understand that any medical or surgical procedure is attended by some risk and that it is not possible to guarantee that successful outcome of any such procedure. This agreement is in force indefinitely from this date unless notify Woodland Veterinary Center in writing on the contrary.
  • Authorization for release of medical records.

    I authorize the Woodland Veterinary Center to acquire any and all medical or surgical records from my previous veterinarian and /or send such information to any veterinarian and/or pet boarding/ grooming facility as requested by us or them
  • Appointment Cancellation/ Late & Reschedule Policy Agreement

    Woodland Veterinary Center is committed to providing all of our patients with exceptional care. When a patient cancels without giving enough notice, they prevent another patient from being seen.
  • Please call us at 219-879-0249 by 3:00pm on the day prior to your scheduled appointment to notify us of any changes or cancellations. To cancel on a Monday appointment, please call our office by 3:00 pm on Friday. If prior notification is not given, you will be charged $25.00 for the missed appointment.

    If you are more than 15 minutes late to your scheduled appointment you will be responsible for a $10.00 late fee and will be seen as a work in (work in can mean anytime from your original appointment to the time we close).

    If you are more than 20 minutes late to your scheduled appointment you will need to reschedule and will be charged a $25.00 service charge.

  • PHOTO CONSENT

    I grant to Woodland Veterinary Center, its representatives and employees the right to take photographs of me/ or my pet, and to copyright, use and publish the same in print and or electronically. I agree that Woodland Veterinary Center may use such photographs of me and or my pet with or without my name and for any lawful purpose, including, for example, such purposes as publicity, illustration, advertising, and Web content.
  • PAYMENT INFORMATION

    • Payment is due in full at the time services are rendered
    • This office does NOT do any billing, we do NOT offer payment plans
    • We accept the following forms of payment:
      • Visa
      • MasterCard
      • Discover
      • American Express
      • Care Credit
      • Cash

    We accept personal checks with a valid Driver’s License or Social Security Number. There is a $25 fee for all returned checks.

    Please print and sign below that you are taking responsibility for full payment of treatment and services for the pets you are bringing in to Woodland Veterinary Center, at the time they are treated. If you are not the individual who is financially responsible for these pets, by signing this form you are stating that you have made prior arrangements with the individual who is. I agree to absolve the Woodland Veterinary Center, veterinarian, and staff employed by the practice of any financial consequences that may occur between you and the other individual you have made prior arrangements with.

  • Date Format: MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.

CONTACT US

Information

  • Woodland Veterinary Center
  • (219) 879-0249
  • 1943 S Woodland Ave, Michigan City, IN 46360
    Mon, Tue, Thu, Fri: 7:30AM-5:00PM
    Wed: 7:30AM-7:00PM
    Sat: 7:30AM-Noon
  • This field is for validation purposes and should be left unchanged.
Sitemap | Accessibility | Website by DOCTOR Multimedia
Font Resize
Contrast
Accessibility by WAH
  • Accessibility
  • Blog
  • Client-Patient Information Form
  • FAQ
  • Home
  • Hospice/End of Life Care
  • New Prairie Small Animal Clinic
  • Parasite Prevention
  • Pet Health
  • Review Us
  • Reviews
  • Sitemap
  • Thank You
  • What Can We Improve?
  • About Our Animal Hospital
  • Our Veterinary Team
  • New Clients
    • Payment Information
    • Pet Insurance
    • Online Forms
  • Veterinary Services
    • AirVet Telemedicine
    • Pet Wellness Plans
    • Acupuncture
    • Veterinary Orthopedic Manipulation
    • Dentistry
    • Microchipping
    • Pain Management
    • Radiology
    • Senior Care
    • Ultrasound
    • Veterinary Cold Laser Therapy
    • House Calls
    • Nutritional Counseling
    • Parasite Prevention
    • Surgery
    • Vaccinations
  • Contact
  • Appointments
Call Us Text Us