Albert Lea Veterinary Clinic

401 Saint Thomas Avenue
Albert Lea, MN 56007-3737

(507)373-8161

albertleavet.com

New Client Check In

If you have not been to our clinic before you can assist us to expedite your check in by submitting this form before you come in for your appointment.  Please submit at least 2 days before your scheduled appointment.  Thank you for helping us assist you! 


New Client

Date (required) :
Name (required)
First Name (required)
Last Name (required)
Address (required)
Street Address (required)
City (required)
,
State / Province (required)
Zip / Postal Code (required)
Daytime Phone (required)
Phone TypePhone Number (required)
Evening Phone (required)
Phone TypePhone Number (required)
E-Mail Address (required) :
Pet's Name (required)

Age: Years, Months

Type of Pet (required) :
Breed:

Sex: (required)
Male
Female


Neutered/Spayed
Neutered
Spayed


Are your pets vaccines current?
Do you have pets medical records?
Medical records at another veterinary Practice?
Yes
No


Name of Former Veterinary Practice

May we request a transfer of records?
Yes
No


Would you like us to call you for your appointment
Reasons or conditions that prompted your visit?

Special requests or conditions?

Please list any additional pets here


Check the reCAPTCHA to ensure you are not a robot: