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Welcome to Bay East Animal Hospital!

New Client Form

Name: Bay East Animal Hospital
Address: 1475 Lime Kiln Rd., Green Bay, WI, 54311, United States
Telephone: 920-468-5800
Price range: $

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Contact

P: 920-468-5800
F: 920-468-5895
E: mail@bayeast.com
Text us: 920-445-8945

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Location

1475 Lime Kiln Rd.
Green Bay, WI 54311

Click here for directions.

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Hours

Mon - Thu: 7:30 am - 5:30 pm
Fri: 7:30 am - 5:00 pm
Sat: Closed
Sun: Closed

Please complete the form below prior to your first appointment. Alternatively, you may click the button below to download the form. If you have any questions, please contact us directly. We look forward to meeting you soon!

Download

Name *

First

Last

Email *

Phone *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Additional Owner

First

Last

Phone

How do you prefer we contact you for appointment confirmations and medical reminders? *

Text
Phone
Email

Other than you and the additional owner listed above, are there any other persons to whom you give primary responsibility for the care of your pet(s)? *

Please list the name, telephone number, and address for any agent to whom you give permission to care for your pet, in the event you are unavailable. (All agents must be 18 years of age or older). *

I understand that my veterinarian will need to communicate with me, or someone designated by me, prior to the treatment of my pet(s). In order to obtain informed consent, I direct my veterinarian as follows: *

Informed consent may be provided by the owner(s) listed above
Informed consent may be provided by the owner(s) above or agents in the order listed above

Bay East Animal Hospital has my permission to release pertinent medical information to any animal facility or shelter. *

Agree
Disagree

On occasion, we like to take photos/videos of your pet during their visit with us. Therefore, we may be interested in using images of your pet(s) and/or family for purposes such as social media, marketing, and client education. We would refer to pet(s) and/or people by first name only, if at all. We would ask for your permission to share them on social media first. *

Bay East has my permission to use images
Bay East does not have my permission to use images

How did you hear about us? *

Website
Phone Book
Referral
Other

Who may we thank?

Professional fees are due at the time services are rendered. We will gladly prepare a written estimate for the procedure(s) to be performed. By my signature, I am verifying the above information is true, and I authorize the release of information accordingly.

I have read and understand.

Signature *

Please type your name.

Date *

Name

Have a question?

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Name *

First

Last

Email *

Phone

How can we help you? *

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Book your next appointment online from any device. We look forward to seeing you soon!

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Welcome to Bay East Animal Hospital!

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