418 East Alfred Street, Tavares, FL 32778
Monday thru Friday 8:00am - 5:30pm
Office: (352) 343-7793 Emergency: (407) 644-4449
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New Client Form
New Client Form
Today's date
*
Do you have an appointment scheduled with us?
Yes
No
If yes, what is the date and time of your appointment?
When you arrive for your appointment, please let us know that you filled out your New Client Form online! Please bring any veterinary history with you, or ask your previous veterinarian to fax records to us at 352-343-7095.
Owner's Name
*
Spouse's Name
Street Address
*
City, State, Zip code
*
Mailing Address, if different
Email Address
*
Home Phone Number
Cell Phone Number
*
Work Phone Number
Spouse Cell Phone Number
Will you allow us to use your pet's photo on our Facebook page/Website? Your name will never be used.
*
Yes
No
How did you hear about us?
*
Pet #1 Name
*
Pet's Date of Birth
*
Pet #1 Species
*
Cat
Dog
Avian
Other/Exotic
If Other/Exotic, please list species
Pet #1 sex
*
Female
Male
Breed
*
Color
*
Is Pet #1 neutered/spayed?
*
Yes
No
Unsure
Pet #2 Name
Pet #2 Date of Birth
Pet #2 Species
Cat
Dog
Avian
Other/Exotic
If Other/Exotic, please list species
Pet #2 sex
Female
Male
Breed
Color
Is Pet #2 neutered/spayed?
Yes
No
Unsure
Do you have more than 2 animals? (If so, we will get their information from you in our clinic)
No
Yes, 3-5
Yes, 6-8
Yes, 9 or more
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