New Client Information – Cat Clinic of Lawrence

Welcome to the Cat Clinic of Lawrence! Prior to your first visit, please fill out the form below.

If you have been to the clinic before with any cat, please fill out the Update Client Information form instead. We have your previous information still on file.

Your Name (primary pet owner)(Required)

First Last

Your Email Address(Required)

Your Phone Number(Required)

Untitled

cell

home

work

Spouse/Partner

First Last

Spouse/Partner Phone Number

Untitled

home

cell

work

Spouse/Partner Email Address

Which email would you like us to use for periodic email updates from the Cat Clinic and appointment reminders for your cat?(Required)

Own email

Spouse/Partner email

Address(Required)

Street Address Address Line 2 City State ZIP Code

Home Phone

Work Phone

Cell Phone

Occupation/Employer

Will anyone else be responsible for the patient? – If so, please list their name, phone number or email, and relationship to you.

How did you hear about the Cat Clinic?

If client referral, who may we thank?

This field is for validation purposes and should be left unchanged.

Full payment is due when services are rendered. We accept Mastercard, VISA, American Express, Discover, Care Credit, checks, and cash. Returned check fee is $35.00.

Monday	8 am - 5:30 pm
Tuesday	8 am - 5:30 pm
Wednesday	closed
Thursday	8 am - 5:30 pm
Friday	8 am - 5:30 pm
Saturday	closed
Sunday	closed