New Client Form

Please:n1. complete the new patient registration formn2. present the completed form to our receptionist when you arriven3. contact your primary care veterinarian to request your pet’s medical records
  • Does anyone else have permission to make decisions on behalf of your pet?
  • I understand that payment in full is due at the time of service. I agree to assume financial responsibility for all professional fees, and agree to pay AVDS when services are rendered. I understand that a fee of 1.5% will be charged on any unpaid balance. AVDS may also recover reasonable attorney’s fees and court costs incurred as a result of my failure to pay in accordance with this authorization.
  • Date Format: MM slash DD slash YYYY
Limited consultations and procedures are also available in:

Affiliated Veterinary Specialists
9905 South U.S. Highway 17-92
Maitland, FL 32751
Phone: 407-644-1287
Fax: 407-644-9075

Animal Emergency and Referral Center
3984 SO. U.S. 1
Ft. Pierce, FL 34982
Phone: 772-466-3441
Fax: 772-466-0206