Lake Animal Hospital Adoption Application

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

If you rent, please make sure your landlord has approved a pet in the residence before submitting an application. All of the information you provide is confidential and will not be shared with anyone outside of the clinic.

First Name, MI, Last name *

Address (#, Street, City, State, Zip Code) *

Phone Number *

Is your residence a rental? If so, please provide your landlord's name and phone number. *

How many adults are in your household? *

What other pets do you have? How old are they? *

How many children are in your household? *

Do you have a regular vet? What is the name of the clinic? *

Are these pets up to date on vaccinations?

Are your pets on heartworm prevention? If so, what brand?

Are your pets on flea and tick prevention? If so, what brand? *

Have you ever surrendered a pet? If so, why?

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms