New Patient Form

Welcome To Our Hospital

We know that your pet’s health is important and we thank you for trusting us to care for them. To help us provide the best care possible, please take a few moments to fill out this form.

For more information on how to reduce stress when bringing your cat in for a visit, please check out these tips.

General Information

Owner Name *

Primary Number *

Secondary Number

Co-Owner Name

Primary Number

Secondary Number

May we contact you at work?

Work Number

Home Address *

City, State *

Zip Code *

Date Of Birth

Month

Day

Year

Driver's License Number *

Driver's License State *

May we send you email/Text reminders and non-emergency lab work results such as intestinal parasite checks? *

How did you select our hospital?

Patient Information

Previous Veterinary Hospital and/or Specialty Center *

Pet Info

Pet Name *

Species *

Fear Free Info for Cats

Breed/Color *

Spayed/Neutered? *

DOB *

Month

Day

Year

Medical Concerns/Agressive *

Pet Info

Pet Name

Species

Breed/Color

Spayed/Neutered?

DOB

Month

Day

Year

Medical Concerns/Agressive

Pet Info

Pet Name

Species

Breed/Color

Spayed/Neutered?

Medical Concerns/Agressive

DOB

Month

Day

Year

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. *

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. I also understand that a deposit of 50% or higher is required for extensive services and hospitalized patients with FULL payment at discharge from the hospital. Any balance that is unpaid will be billed to me at 30 days, if not paid within 14 days the balance will be forwarded to Boca Park Animal Hospital’s collection agency, and I will incur a 35% collection fee for which I am liable, in addition to monthly finance charges. If Boca Park Animal Hospital collection agency must pursue court action I will be liable for court costs and attorney fees. Boca Park Animal Hospital does not except payment plans, please ask about other payment options. *

I agree

New Patient Form

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