11619 Pleasant Ridge Rd, Little Rock, AR 72212 US
501-224-3784

New Patient Form: Ophthalmology

If your pet has an upcoming Ophthalmology appointment with Dr. William (Bill) Miller or Dr. Petra Lackner, please complete the specialty form using one of the options below. 

OPTION 1
Complete Online

Complete and submit the form below.

OPTION 2
Print & Complete

Bring the completed form with you.

Download PDF

OPTION 3
Complete on Arrival

If you prefer, you can complete the form when you get to our hospital.

Ophthalmology Patient Medical Questionnaire

Please answer the following questions to the best of your knowledge. 


Consent for Treatment

I understand that the estimated costs for medical or surgical treatment of this patient and the actual costs may vary. I certify that I am the owner or authorized agent of this animal and do authorize the examination, medical, surgical or other treatments as they are explained to me and are deemed necessary.
By submitting this form, I agree to the above.

From Our Clients

  • "This place was awesome. The staff was wonderful. They explained everything to us, took amazing care of our fur baby and kept us updated. They even gave me an update (I even spoke directly to the vet) when I called at 1:30 in the morning! I would recommend this place to anyone."
    Tanya C.

501-224-3784