New Patient Form

Save time during your next appointment. Complete your required forms online from any device at any time before your visit.

New Patient Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pets before your visit.
You may use the PDF version by clicking the DOWNLOAD FORM button and then completing the printed form by hand. Please bring the completed PDF form with you for your pet’s first appointment.

Client Information

Lifelong Pet Health Care use only for vaccine/medical records, lab results, imaging results, and reports.

Pet Information

Please fax/email vaccines and medical history prior to the visit, if applicable. Fax: 785-267-2575 or lifelongpetstaff@gmail.com

Payment Policy

We will gladly prepare a written estimate if you desire (please ask our doctor or receptionist). ALL PROFESSIONAL FEES
ARE DUE AT THE TIME SERVICES ARE RENDERED. In cases of extensive medical or surgical procedures where
full payment may be difficult at discharge, we accept major credit cards. In-clinic care credit application processing (2 forms
ID required), with results in minutes.

To prevent the spread of infectious diseases, all hospitalized patients must be current on all vaccines and free from all internal and external parasites. The signature below authorizes this level of preventive care and the appropriate charges will be assessed in the discharge invoice.

Clear Signature