New Client Forms

Client Information
Your Name

First Name Last Name
Spouse/Significant Other/Acting Agent

First Name Last Name
Mailing Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Primary Phone Number
Please enter a valid phone number.
Secondary Phone Number
Please enter a valid phone number.
Spouse/Significant Other's Phone Number
Please enter a valid phone number.
Email
example@example.com
Patient Information

Please enter your pet's information below. If you have additional pets, please use the additional columns.

	First Pet	Second Pet	Third Pet	Fourth Pet
Pet's Name
Species
Sex
Spayed/Neutered
Breed
Color/Markings
Birthdate/Age
Date of Last Vaccinations

Previous Medical History

Please reach out to your previous veterinary hospital and request records be emailed to parkavenueah@yourvetdoc.com or faxed to us at 407-884-5654. We will need those in hand before your appointment.
Previous Veterinary Hospitals

Our Hospital Policies

Thank you for choosing Park Avenue Animal Hospital for the care of your pet. We are proud to provide the highest standards of veterinary care available to maintain the quality life your pet deserves. In order to serve you and your pet(s) to the best of our abilities, please review this statement of hospital policy, initial next to each section and sign below.
Initial here Office hours are by appointment only. If you bring your pet in without an appointment, you may be asked to wait until an open appointment is available, or to leave your pet in our care until a doctor is available, unless the situation is considered an emergency. Any appointments not previously scheduled may incur a work in/walk in or emergency fee.
Initial here For the safety of everyone's pets, no animal shall be accepted into Park Avenue Animal Hospital for boarding, bathing, hospitalization, surgery or any situation where the animal is required to stay for any amount of time beyond a standard appointment, without record of up to date vaccinations. Vaccinations required for dogs include Rabies, DA2PP (Distemper,) Influenza and Bordetella (Canine Kennel Cough.) Vaccinations required for cats include Rabies and FVRCP (Feline Distemper.) If these vaccinations are due at the time a patient is required to stay in our facility, your initials authorizes our doctors to bring any vaccinations up to date that may be due at the time of your pet's arrival. Rabies vaccinations are required for any grooming technician appointments such as nail trims, anal gland expressions, ear cleanings, etc.
Initial here When leaving your pet at our facility for any reason (dropping off for an exam, boarding, surgery, etc.) please allow 10-15 minutes so that we may process the appropriate paperwork. You may also be asked to wait to speak with a doctor or technician, depending on the situation. For major surgeries, a deposit may be required before taking in your pet.
Initial here Our facility is not set up for billing. 100% payment is due at the time services are rendered. For your convenience, we accept American Express, Visa, Mastercard, Discover and debit, as well as cash and checks. *We do NOT currently accept CareCredit.* Please be prepared to offer a secondary form of payment, should your primary method of payment be declined.
Initial here Our office currently has modified procedures as part of our ongoing COVID protocol. Please refer to our website for our current COVID protocols.
By signing below you verify that you have read, understand and do agree to the terms listed above. Your signature authorizes Park Avenue Animal Hospital and its doctors to provide veterinary care to the animal or animals listed on your original registration form, and additional animals that may be added to your account in the future.
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Client Information

Patient Information

Previous Medical History

Our Hospital Policies