Existing Client Form in Windermere, FL | Animal Clinic of Windermere

Owner Name*

First Last

Pet's Name*

Reason for Visit?*

Preferred Doctor*

Preferred Date*

Preferred Time*

:

I/we hereby authorize the veterinarians to examine, prescribe for, or treat my pets (s). I/we assume full responsibility for all charges incurred in the care of this/these animal(s). I/we also understand that these charges will be paid in full at the time of release and that a deposit may be required for certain surgical treatments or other procedures.

Signature*