leitchfieldvet@gmail.com

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Book Appointment

Home
About Us
Services
Resources
Careers
Shop Food & Meds
Contact
Book Appointment

New Client Form

Welcome to Leitchfield Veterinary Clinic—we’re glad you’re here. Our New Client Form helps us learn a little more about you and your pet before your first visit, so we can provide a smooth check-in experience and personalized veterinary care from the start.

How to Complete the Form

To help us serve you best, please:

Fill out all required fields for owner and pet information
Share any current symptoms, medications, or ongoing conditions
Include prior veterinary records if available (or bring them to your appointment)
Submit the form before your scheduled visit whenever possible

If you have multiple pets, please submit a separate form for each pet.

New Client Form

Name *

First

Last

Email *

Primary Phone *

Secondary Phone

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Who else is authorized to make decisions about your pet's healthcare? *

First

Last

Phone

How did you find out about our hospital? If you were referred by someone, who should we thank? *

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

Do you have a second pet? *

Yes
No

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

Do you have a third pet? *

Yes
No

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

Do you have a fourth pet? *

Yes
No

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

Do you have a fifth pet? *

Yes
No

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

Payment is due in full at the time that services are performed. If being admitted into the hospital, we cannot begin the care of your pet until you have confirmed your desire to do so by 1) signing the client consent & estimate form, and 2) leaving an initial deposit of 50% of the upper end of the estimate. This is the only way that we have of knowing for certain that you want us to proceed with the care of your pet. We accept Cash, Visa, MasterCard, Discover, and CareCredit payments. We neither extend credit, nor bill for services. All open invoices are sent to collections after 45 days unless prior arrangements are made. *

I have read and accept the financial policy.

Email

Need Help or Have an Urgent Concern?

If your pet needs immediate assistance, do not use this form. Please contact our team directly so we can help you right away.

Schedule Your Pet’s Visit Today

Leitchfield Veterinary Clinic provides full-service veterinary care for dogs, cats, large animals, and select exotic species in Leitchfield and surrounding areas, including Grayson County, Breckinridge County, Edmonson County, Hart County, and Hardin County. From wellness exams and surgery to diagnostics, large animal care, and integrative services, our experienced team is here to support every stage of your animal’s life.

Book Appointment

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Our Location

676 Commerce Drive
Leitchfield, KY 42754

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Contact Us

Phone: (270) 259-9355
Email: leitchfieldvet@gmail.com

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Hours of Operation

Monday – Friday: 8 AM – 5 PM
Saturday: 8 AM – 12 PM
Sunday: Closed

Get in Touch

Your questions and concerns are always welcome at Leitchfield Veterinary Clinic. Reach out to our team today by completing our online form.

Name *

First

Last

Email *

Phone

How can we help you? *

Name

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