Tel: (352) 686-0671

3449 Deltona Blvd, Spring Hill, FL, United States

Competent Compassionate Care for Your Pet

ANIMAL MEDICAL CLINIC
‚ÄčOF SPRING HILL


Client Information Sheet

Animal Medical Clinic
3449 Deltona Boulevard
Spring Hill, FL 34606

Welcome to the Animal Medical Clinic! 

First Name:
Last Name:
Spouse:
Address Street 1:
City:
State:
Zip Code: (5 digits)
Home Phone:
Cell Phone:
Work Phone:
Employer:
Email:
Driver's License No.:
SS#:  (Requested, not required)
How did you first hear about us?:
   Please tell us about your pet:
Pet's name:
Type of pet? DogCatBirdOther
Breed:
Color:
Neutered?  YesNo
 Sex:
MaleFemale
Birth date (or estimated age of pet):
Prescription medicines:
Signature of Owner:
Please click the box below to authorize treatment of your pet. Thank you.
  I hereby authorize the staff of the Animal Medical Clinic to examine and treat the above described animal. I understand that payment for serices rendered is required at the time the animal is discharged from the clinic
How will you be paying today? MC/VISAAMX/DSCCHECKCASHDEBIT
  Please note our Financial Policy below.

Financial Policy
ALL PAYMENTS ARE DUE AT TIME OF SERVICE, WE DO NOT DO PAYMENT PLANS OR TAKE POST DATED CHECKS.

Personal Checks: The Animal Medical Clinic reserves the right to refuse a personal check from any new client.

Returned Checks: There will be a fee (currently $20.00) for any returned checks returned by the Bank.  If payment is not received on a returned check, we have the right to refuse future services and/or request alternative payment method.