Due to an abundance of no show/no calls, EFFECTIVE July 1st, 2022 a 24-hour cancellation notice is required. If no 24-hour notice is given you will be REQUIRED to pay a $50.00 deposit on your account before we can schedule another appointment for you.
Leave a message on our medication line: 419.238.3931 OPTION 1.
Include your first and last name, phone number, pet’s name, and medication(s) requested. Or see our ONLINE PHARMACY.
Thank You for your cooperation!

Animal Clinic of Van Wert

New Client Form

Save time on your next appointment by filling out our online New Client Form.

Get Started

New Client Form



Owner Information

Name *

First

Last

Spouse's Name

First

Last

Who may we thank for referring you?

Driver's License #: *

Contact Information

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Primary Phone *

Work Phone

Cell

Spouse's Phone

Spouse's Work Phone

Spouse's Cell

Email *

We are collecting e-mail addresses for our own future use to include vaccination reminders, special hospital events or new products and services. We respect your privacy.

Patient Information

Pet's Name *

Sex *

Male
Neutered Male
Female
Spayed Female

Species *

Dog
Cat
Rabbit
Ferret
Other

If other, please specify: *

Breed *

Age/Date of Birth *

Color *

Please tell us the reason for your visit: *

Informed Consent

I certify that I am over 18 years of age and will assume responsibility for all charges incurred in the care of this pet. I understand that FULL PAYMENT IS DUE AT THE TIME SERVICE IS RENDERED and a DEPOSIT IS REQUIRED FOR ANY HOSPITALIZED PET. *

I have read and accept the financial policy.

How will you be paying for veterinary services today?

Cash
check
Visa/Mastercard/Discover
Debit Card

Signature

Phone

Ready for a Visit?

We proudly serve the pets of Van Wert, OH and the surrounding areas. We look forward to seeing you and your pet! You may request an appointment by clicking the button below.

Appointment

Information Prescription Refills Requests:

Regarding Prescription Refills Requests:

DO NOT WAIT UNTIL YOU ARE OUT OF YOUR PETS MEDICATION before calling to request a refill.

Please allow 48-hour notice for your pet’s prescriptions to be filled. This allows our staff time to check the pet’s medical records, make sure no changes are needed and prepare the medication.

Please note that some medications require an examination or testing before refilling. Some medications are special orders or may not be in stock.

Leave a message on our medication line: 419.238.3931 OPTION 4.
Include your first and last name, phone number, pet’s name, and medication(s) requested.
Thank You for your cooperation!

Animal Clinic of Van Wert

Have A Question?

Get in touch!



Address

13995 Lincoln Hwy
Van Wert, OH 45891



Contact

P: 419-238-3931
F: 419-928-3173
E: [email protected]



Hours

Mon – Fri: 8 am – 12 pm | 1 pm – 5 pm
Sat: 9 am – 12 pm
Sun: Closed