New Client Form

Thank you for choosing Calusa Crossing Animal Hospital as your preferred Miami, FL veterinarian! Please fill out the following form before your booked appointment.

Get Started

Welcome new clients!

We are glad to have the opportunity to care for your pet. To ensure your pet gets the best care we can offer, please fill out the following form completely. Please Note: All * fields are required.

Name *

First

Last

Email *

Primary Phone *

I consent to receive SMS text messages from Calusa Crossing Animal Hospital. Msg & data rates may apply. Reply STOP to opt-out. *

Secondary Phone

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Who else is authorized to make decisions about your pet's healthcare? *

First

Last

Phone

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

Pet Insurance Provider?

Emergency Contact *

First

Last

Phone *

Pet Health History

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Color/Markings *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Current medications your pet is taking (if none, write none) *

Vaccines your pet has received

Distemper
Parvovirus
Rabies

Primary reason for visit *

Prior Surgeries (if any)

Prior Illnesses (if any)

I hereby authorize the veterinarian to examine, prescribe for, or treat the above described pet. I assume responsibility for all charges incurred in the care of the animal. I also understand that all professional fees are due at the time services are rendered.

Signature of the responsible party *

Clear Signature

Date *

Phone

New Client Form

Welcome new clients!

Pet Health History

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