New Client Intake Form | New Port Richey Veterinarian | All Pets Hospital

New Client Intake Form

  • Client Information

  • Pet Information

  • Proof of rabies vaccination is required before treatment of any pet. If the pet is not currently vaccinated All Pets Hospital requires immediate vaccination before continuing treatment.

    By signing this form you are authorizing All Pets to request medical records from previous veterinary practices.

    • I understand that by signing this form I am agreeing to pay for the services and products that my pet receives.
    • I understand that I may request a written estimate of fees prior to any care provided.
    • I understand that payment in full is expected when treatment is performed or animal is released from the hospital. Payment may be cash or Credit Card only. WE DO NOT ACCEPT CHECKS.
    • I understand that in case of an emergency hospitalization, deposit arrangements must be made with the receptionist.
    • I understand that I am liable for any court costs or other fees incurred during the collection of my bad debts.
    • I understand that All Pets Hospital follows the Federal Trade Commission (FTC) rules. Therefore we do not store in any way credit card numbers, photo ID’s, or any other form of payment for future use. We also are not able to bill, leave outstanding balances, or mail invoices to clients.
  • How Did You Hear About Us

  • Please input your legal first and last name

  • MM slash DD slash YYYY

  • This field is for validation purposes and should be left unchanged.