New Client Form

Live Oak Animal Hospital

Old Dixie Highway SW, Vero Beach, FL 32962

Phone: (772) 770-4263 Fax: (772) 778-4571

New Client/Patient Form

Welcome to the Live Oak Family!

Please provide the following information so that we can make sure your pet's appointment runs smoothly.

New Client (Owner) Information:

Client / Owner Information
How do you prefer that we contact you?
How did you hear about us?

(With our Share the Care referral program, both of you will receive a $10.00 credit)

Did you recently acquire your pet?
Are they up to date on Vaccines?
May we contact them for medical records (if you do not have them)?

I understand that full payment is due at the time service is rendered, and that a deposit is required for any hospitalized pet.

All unpaid balances are subject to a 1.5% per month interest charge.

In the event legal action is required to recover an unpaid balance, I agree to pay all interest, court costs, and attorney's fees.

I authorize the release of my pet's medical records to Live Oak Animal Hospital and hereafter waive the written release requirement pursuant to Florida code.

I hereby authorize the veterinarian to examine, prescribe for or treat the above-described pet(s). I assume responsibility for all charges incurred in the care of this animal. I also understand that these charges must be paid in full, at the time of release of the pet.

Sign above