New Client Form

Name: Veterinarian
Brand: Boca Park Animal Hospital

CLIENT / OWNER INFORMATION

Owner Name

Owner Cell Number

Co-Owner Name

Co-Owner Cell Number

Emergency Number

Street Address

Address Line 2

City

State/Province

ZIP Code

PET INFORMATION

Previous Veterinary Hospital and/or Specialty Center

PET 1

Pet Name

Species

Breed/Color

Spayed/Neutered

DOB

Medical Concerns/ Aggressive

PET 2

Pet Name

Species

Breed/Color

Spayed/Neutered

DOB

Medical Concerns/ Aggressive

Does your pet have health insurance and if so what is the company’s name?

PHOTO RELEASE AND FINANCIAL POLICY

Photo Release: I hereby grant Boca Park Animal Hospital the right to photograph my pet and the irrevocable right to use the photographs in all types of advertisement including but not limited to display on social media outlets, display on the world wide web, and display and/or broadcast on all other outlets know or unknown, for any purpose whatsoever.

Yes

Initials

Appointment Policy: You are considered late for your appointment if you arrive 10 minutes or more after your scheduled time. Late appointments are considered a walk-in appointment, this incurs a significant increase in cost for the exam fee, and a possible wait may occur, or you may reschedule your appointment for a different date. By signing below, you agree to this policy.

Financial Policy: By signing below I assume full fiscal responsibility for any treatment my pet receives. I understand that FULL payment is due at the time services are rendered.

Signature of Owner:

Sign above

New Client Form

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Boca Park Animal Hospital