Owner's Information

Are you the owner of this cat(s) or dog(s)? *

Yes
No

(If you answered “No” and you are not currently here for an appointment, please give us a call. If you are already here for your appointment, please let one of our team members know that you are not the owner.)

Have you made an appointment already? *

Yes
No

Please note: We will not contact you for an appointment. You need to call us to schedule an appointment. This form is not an appointment request. Please give the office a call at 352-688-9911.

If yes, what date is your appointment scheduled for? *

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Primary Phone Number *

Secondary Phone Number

Driver's License Number *

Email *

(For appointment confirmations, reminders, etc.)

Spouse/Co-Owner's Name

First

Last

Spouse/Co-Owner's Phone Number

Name of previous veterinarian *

Phone number of previous veterinarian *

Preferred Method of Contact (select all that apply) *

Text
Email
Call

**Standard text messaging rates may apply from your carrier.**

How did you first hear about Kind Animal Care? Please check all that apply *

Whom may we thank for the referral? *

Please specify which online source *

If other, please specify *

Pet's Information

Pet's Name *

Species *

Dog
Cat

Does your pet have a microchip? *

Yes
No

Age/Date of Birth *

Breed *

Color *

Sex *

Male
Male (neutered)
Female
Female (spayed)

Is it okay to post a photo of your pet on our Facebook or Instagram account? *

Yes
No

Would you like to add another pet? *

Yes
No

Pet's Name *

Species *

Dog
Cat

Does your pet have a microchip? *

Yes
No

Age/Date of Birth *

Breed *

Color *

Sex *

Male
Male (neutered)
Female
Female (spayed)

Is it okay to post a photo of your pet on our Facebook or Instagram account? *

Yes
No

Would you like to add another pet? *

Yes
No

Pet's Name *

Species *

Dog
Cat

Does your pet have a microchip? *

Yes
No

Age/Date of Birth *

Breed *

Color *

Sex *

Male
Male (netuered)
Female
Female (spayed)

Is it okay to post a photo of your pet on our Facebook or Instagram account? *

Yes
No

Financial Policy

Our policy is to provide you with a written medical treatment plan of fees required for in-clinic treatment, emergency care, surgery, and/or hospitalization. A deposit is required prior to any treatment and for all hospitalized animals. Full payment is due at time of services. Hospital accounts must be kept current throughout the period of hospitalization. If you do not pick up your pet within 10 (ten) days of its release date, your pet will be considered abandoned. Your total bill, which is to include the treatment charges plus the ten additional days of hospitalization will be turned over to a national collection bureau, to be placed on your credit record. *

Please Initial

Payment Policy

We accept the following forms of payment: Cash, Visa, Mastercard, American Express, Discover, Scratchpay, and Care Credit*. We do NOT accept checks as a form of payment. *If using Care Credit, the card holder must be present at the time of payment. *

Please Initial

Zero-Tolerance Policy

Kind Animal Care is committed to providing a welcoming and safe environment for our staff, clients, and patients. We have a zero-tolerance policy for abusive behavior by clients. Behaviors that will not be tolerated include physical assault, verbal harassment, foul or abusive language, threats of any kind, harassment of any kind, destruction of property, and aggressive behavior toward staff members or pets. Clients who engage in any of these behaviors while on clinic property will be asked to leave immediately and will no longer be able to seek care at Kind Animal Care or any of its affiliates. We reserve the right to terminate the clinic’s relationship with any client who, in our judgement, violates this policy. Copies of patient(s) medical records will be sent immediately to the address on file and no further services will be offered.

I have read and understood the above policies and request treatment for my pet in accordance with these policies. I assume all financial responsibilities for all charges incurred to the patient (pet) and agree to pay all costs of collection and/or fees in the event of non-payment. *

Please Initial

Signature *

Date *

New Clients Welcome!

We can’t wait to meet you!

New Client Form

New Client Form

Owner's Information

Pet's Information

Financial Policy

Payment Policy

Zero-Tolerance Policy

How to contact us

Location

Contact Info

Hours

Get to know us

Send us a message!