Client Registration Form

  • Client Information:

  • Discount Eligibility:

  • Additional Authorization

    Additional persons authorized to accompany my pet(s) at their appointments and/or make medical and financial decisions for my pet(s):
  • Referral

  • (We have a referral program and like to thank our clients!)
  • Pet Information

  • Information and Liability Release

    Please check to indicate that you have read the following:
  • Deposits and Payments

    For any and all medical care, service and/or treatment performed at Tuscawilla Oaks Animal Hospital, payment will be due at the time services/treatments are rendered. In addition, if your pet is hospitalized, 50% of the treatment plan will be collected as a deposit prior to admission and the balance to be paid upon hospital discharge. You may be asked to make additional payments towards your account if additional treatments are deemed necessary during hospitalization. A $75.00 deposit will be obtained in order to schedule ANY surgical or dental procedures performed by our veterinarians. A $100.00 deposit will be obtained in order to schedule any mobile specialist consultation or procedure.
    We accept Cash, Visa, MasterCard, Discover and American Express along with third party funding, such as Care Credit (w/minimum of $200), Scratch Pay, etc.
  • Understanding/Acknowledgment/Agreement

    My signature below indicates and acknowledges that I have read and fully understand and consent the policies and procedures as listed above by Tuscawilla Oaks Animal Hospital.
  • Date Format: MM slash DD slash YYYY