Thank you for the opportunity to care for your pet!

Please take a moment to complete this information sheet for the creation of your pet’s hospital records. Additionally, you may download the form, print it, and bring it with you to your next appointment.

Download New Client Form

Client Information

Animal Medical Information

How did you first hear about us?

Is your pet on heartworm prevention?
Is your pet on using Flee prevention?
  • I request that the doctors and staff at West Palm Animal Clinic perform the services which are necessary to the examination and medical treatment of the animal(s) presented by me. I am the owner or agent for the described animal(s) and have authority to execute this consent.

  • I authorize the veterinarian on duty (and assistant they may designate) to examine the animal(s) and to administer the examination findings. I therefore, hereby consent to and authorize the performance of such procedures as deemed necessary and desirable in the veterinarian’s professional judgment.

  • I understand that the treatment of the patient(s) will be conducted with due care and in accordance with the prevailing standards of care in veterinary medicine. I certify that no guarantee or assurance has been made as to the results that may be obtained through the course of treatment undertaken by the provider.

  • I agree to pay all attorney’s fees, finance charges, collection cost and other cost of litigation incurred in the collection of past accounts.

  • I understand that a written estimate for charges will be provided at my request. I also consent to the release of medical information.

  • I assume the responsibility for all charges incurred to the patient for services rendered and understand that full payment is required upon request.