WE ARE PLEASED TO WELCOME YOU TO OUR PRACTICE.

Please take a few minutes to fill out this form. If you have any questions we'll be glad to help. We look forward to working with you in maintaining your pet's health.


CLIENT INFORMATION


 

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PET INFORMATION


 

Dog Cat Other
M F
Yes No
DHLP(Distemper-Dog) Feline Leukemia Test (Cat) Rabies(dog/Cat) Parvovirus (dog) FVRCP(Infectious Diseases-Cat) Dentistry
Behavior Problems Lack of Appetite Sneezing Bleeding Gums Limping Thirst and / or Urination Increased Breathing Problems Loss of Balance Vomiting Coughing Scooting Weakness Diarrhea Scratching Eye Bulging or Bloodshot Seems Depressed Gagging Shaking Head
I hereby authorize the veterinarians of Miami Pet Clinic or their assistants to perform services, procedures, diagnostics, treatments and/or administration of extra label medications within accepted veterinary guidelines as deemed advisable and/or necessary for my pet(s) I authorize Miami Pet Clinic to obtain all medical records regarding my pet from anu other hospital and, its subsidiaries, parents and affiliates. Although Miami Pet Clinic will take every reasonable action to ensure the success of my pet's procedure(s), I understand that there is a risk of complications with every procedure, including the possibility of death as a severe complication of surgery, anesthesia, or other procedures, the nature and the risk of any procedure(s), including surgery and anesthesia if applicable, will be explained to me and any questions I may have will be answered, before I leave my pet or allow treatment. I undestand that blood work is recommended prior to any procedure involving the use of anesthesia to ensure the best outcome for my pet and to avoid possible complications. I understand that Miami Pet Clinic staff may not be present in the hospital overnight. I understand that there is no guarantee nor can one be made as to results or cure of any treatment.I assume full financial responsibility for all charges incurred by my pet and I understand that payment is due in full at the time of services are rendered. If for any reason payment is not made at the time services are rendered or within 10 days thereafter, I understand that my account may be referred to a collection agency. In the event that my account is referred to a collection agency, I agree that Miami Pet Clinic may add an amount to my outstanding account balance to reimburse Miami Pet Clinic for the reasonable collection charge (but not including attorney's fees) imposed by the collection agency. In the event of any an emergency, or as determined by the veterinarian, it may become necessary to take my pet outside the Clinic. I authorize Miami Pet Clinic to walk or transport my pet outside the Clinic. I understand that Miami Pet Clinicwill take reasonable precautions to ensure the safety of my pet while in their care. We will gladly prepare a written estimate of service fees if you desire(please ask our doctor or receptionist) In case of extensive medical or surgical procedures where full payment may be difficult at discharge, we accept major credit cards or can stablish a payment arrangement if approved in advance of treatment. CHECKS NO ACCEPTED. By signing below, I certify that I have read and understand the above information.

Full Service Veterinary

Our Pet Clinic

Our animal hospital provides everything your pet needs to stay happy and healthy in Miami and nearby areas.
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