(507) 332-0716
faribault@heartlandanimalvets.com
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New Client Form

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

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New Client Form

Please complete this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

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

We would love to see you!

We proudly serve Lonsdale, Northfield, Faribault, Farmington, Owatonna, Kenyon, Medford, Dodge Center, and beyond. Our mission at Heartland Animal Hospital is to provide quality, compassionate medicine. You can find us in Faribault, MN at (507) 332-0716 .

Request An Appointment

Get in Touch

If this is an emergency, please call our clinic. You will receive confirmation from our staff within 48 hours of your appointment time and date. Thank you.

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Address

1200 Lyndale Ave N.
Faribault MN 55021

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Contact

Phone: (507) 332-0716
Email: faribault@heartlandanimalvets.com

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Hours

Monday – Friday: 8 AM – 5 PM
1st and 3rd Saturdays: 8 AM – Noon
(Call for Appointment)

Name *

First

Last

Email *

Phone

How can we help you? *

Phone

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