Paradise Animal Hospital - New Client Form

Owner Information

Name(Required)

First Last

Email(Required)

Phone(Required)

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Patient Information

Patient Name(Required)

Species(Required)

Pet Age(Required)

Breed(Required)

Sex(Required)

Color(Required)

Is your pet microchipped?

Yes

Microchip #

Current Medications

Special Diet

Previous Veterinary Hospital Name

Previous Veterinary Hospital Phone

Please upload any medical records

Drop files here or

Max. file size: 8 MB.

TO PREVENT THE SPREAD OF INFECTIOUS DISEASES AND PARASITES, WE RECOMMEND ANIMALS TO BE CURRENT ON ALL VACCINES. PETS WITH FLEAS WILL BE TREATED WITH AN ORAL FLEA MEDICATION ON ADMISSION, AND THE PRESCRIPTION PRICE WILL BE INCLUDED IN THE INVOICE. I AUTHORIZE ADMINISTRATION OF VACCINES AND PARASITE CONTROL AS NEEDED FOR MY PET(S). *

Name(Required)

First Last

We will gladly discuss cost of services and/or prepare a written estimate for recommended procedures. Professional fees are due at the time services are rendered. Deposits may be required for pets being admitted. We accept cash, checks, debit cards, Visa, Mastercard, American Express, Discover, and Care Credit. We charge a $30.00 fee for returned checks.