New Client Registration

PRINTABLE PDF

Name
First Last
Address
Street Address Address Line 2 City State Zip Code
Email
Primary Phone
Home Phone
Work Phone
How did you hear about us?
- Sign
- Recommendation
Who recommended you?
Thank you for choosing Louisburg Veterinary Hospital! Our primary mission is to provide compassionate care, affordable rates, and superior comprehensive veterinary care with a family approach. We diligently strive to ensure that the cost of quality veterinary care is as economical and manageable for our clients as possible by offering multiple payment options.

We offer multiple payment options in the form of: Cash, Check, Visa, MasterCard, Discover, American Express, and Care Credit.

**All returned checks will be charged an additional $35.00.**

Any necessary treatments and/or hospitalized care will be provided an estimate and a REQUIRED deposit amount of 50% of the estimated cost of care is due prior to procedures.

**Louisburg Veterinary Hospital requires payment in FULL at the time of check out.**

By signing below, you acknowledge and fully understand the Louisburg Veterinary Hospital financial policy and agree the Louisburg Veterinary Hospital terms of payment.
Electronic Signature*
Photo Consent

I hereby grant Louisburg Veterinary Hospital permission to take photographs of my pet(s), and to publish those photographs for any lawful purpose, including but not limited to their website, social media accounts, and promotional materials either digital or in print, in perpetuity. I understand that Louisburg Veterinary Hospital will not use my name or my pet's name.

By electronically signing this form I authorize Louisburg Veterinary Hospital to edit and share the photograph(s) mentioned above. I also waive any rights of privacy or compensation associated with the use of my pet(s) image(s) for the personal or commercial purposes outlined above.
Electronic Signature
Pet Registration
1st PET INFORMATION
Pet Name
Species
- Dog
- Cat
- Reptile
- Exotic
Breed
Color
Date of Birth
MM slash DD slash YYYY
If unknown, approximate age:
Sex
- Male
- Female
Spayed/Neutered?
- Yes
- No
Is your pet up to date on vaccines?
- Yes
- No
Please list prior illnesses, surgeries, or allergies:
Is your pet currently on any medications?
- Yes
- No
Names and dosage:
2nd PET INFORMATION
Pet Name
Species
- Dog
- Cat
- Reptile
- Exotic
Breed
Color
Date of Birth
MM slash DD slash YYYY
If unknown, approximate age:
Sex
- Male
- Female
Spayed/Neutered?
- Yes
- No
Is your pet up to date on vaccines?
- Yes
- No
Please list prior illnesses, surgeries, or allergies:
Is your pet currently on any medications?
- Yes
- No
Names and dosage:

Louisburg Veterinary Hospital

115 N Church St
Louisburg, NC 27549

Call or Text: (919) 496-2638
Fax: (919) 496-2699
Email: [email protected]

Hospital Hours

Mon, Tues, Wed, Fri: 8:00 AM – 5:30 PM
Saturday: 8:00 AM – 12:00 PM
Closed Thursday & Saturday

New Client Registration

Pet Registration

Louisburg Veterinary Hospital

Hospital Hours