954-287-4368
Fort Lauderdale, FL
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Home
About
Our Story
FAQs
Reviews
Services
Resources
Online Forms
New Client Form
Payment Options
Careers
Contact
Call (954) 2urgent
New Client Form
Please fill out our form below!
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New Client Form
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Who else is authorized to make decisions about your pet's healthcare?
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First
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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
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Age/Date of Birth
*
Sex
*
Male
Neutered Male
Female
Spayed Female
Does your pet have a microchip identification?
*
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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 (copy)
*
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.
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