Name *

First

Last

Spouse's Name

First

Last

Email *

Phone

Work Phone

Cell Phone

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Place of Employment

Best Number to Reach You

Authorizing Signature for Release of Records *

All Fees Are Due At The Time Services Are Rendered

(We see appointments in the following order: Emergencies, Scheduled Appointments, Walk-in/Work-ins.) Please indicate choice of payment. Cash, Visa, MasterCard, Discover, Care Credit. *Pet insurance is also available. No personal checks until after the 3rd visit.

How did you find out about our hospital? If you were referred by someone, who should we thank? *

(Drove by, Yellow Pages, Previous Client, Personal Recommendation, Other)

Pet's Name *

Species *

Cat
Dog
Other

If Other, please explain: *

Breed *

Color *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Pet #2 Name

Species

Cat
Dog
Other

If Other, please explain:

Breed

Color

Age/Date of Birth

Sex

Male
Neutered Male
Female
Spayed Female

Pet #3 Name

Species

Cat
Dog
Other

If Other, please explain:

Breed

Color

Age/Date of Birth

Sex

Male
Neutered Male
Female
Spayed Female

YOUR DOG’S VACCINATION HISTORY:

Please list history for the following: RABIES, DA-CPV, BORDETELLA, LEPTO, HEARTWORM TEST, FECAL

YOUR CAT’S VACCINATION HISTORY:

Please list history for the following: RABIES, CVRC (FVRCP), FELV, FELV/FIV TEST, FECAL

Our pet(s) is:

Member of our family
Child’s pet
Backyard pet
Inside/Outside

Any previous serious illness or surgeries?

Any allergies to vaccinations or medications?

Is your pet on any special diets or medications?

Please note: New Clients are required to place a $40 non-refundable deposit to book a first appointment. No-shows will not be refunded but you are welcome to reschedule as needed. Please call us after completing this form to place the deposit and schedule your appointment. *

I have read and understand.

We at Saunders Veterinary Services strive to give you & your pet the best personal, professional & medical attention that you deserve. It is our policy to charge an exam fee for any appointments that are not canceled 24 hours prior to the appointment time.

New Client Form

New Client Form

Your preferred Avon Park veterinary hospital.

Questions?

Contact Us

Location

Contact Information

Hours

We proudly serve the pets of Avon Park, FL, and beyond.