Primary Phone * Secondary Phone Email * Employer Phone * How did you become aware of our services? If recommended, whom may we thank? Pet Information Pet's Name * Species (dog, cat, etc.) * Breed * Color * Age/Date of Birth * Has your pet visited a Veterinarian in the past? * Please list any other important information about your pets: Do we have permission to take pictures of your pet(s) to use for marketing and promotional purposes. * Practice Policies
Accounts: All charges are due and payable at the time services are rendered. We will accept payment by cash, check, or credit card.
Standards and Ethics: Village Veterinary Center endorses the principles of the Louisiana Board of Veterinary Medicine and the American Veterinary Medical Association. It is our intention to provide thorough medical care for our patients in strict compliance with these standards.
Cancellation Policy: If you are unable to keep a schedule appointment, please give a minimum 24 hours notice of cancellation. Any missed, uncancelled appointments will be charged a $72.00 fee. After-Hour Emergencies: Please call, Lafayette Animal Emergency Clinic, 337-989-0992, 206 Winchester Dr, Lafayette, LA 7D506. Additional Pet Information Pet's Name * Age/Date of Birth * How long have you had him/her? * Where did you get him/her? * When was his/her last set of vaccinations: * Please check off which vaccines were given: Is he/she currently on any medications? * Where does he/she spend most of his/her time? * Does he/she come in contact with any other pets/animals? * What do you feed your dog/cat? * If offered table scraps or treats, list examples: * Please check any of the conditions that your pet has experienced: * Is he/she on heartworm preventative? * Is he/she on flea/tick preventative? * Please list any other questions/ or concerns you might have: Please select your preferred Veterinarian