Phone: (786) 542-6070  -  

7337 SW 8th St, Miami, FL 33144

Miami Animal Clinic

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New Client Form

OWNER/DUEÑO

Name*
Address / Direccion*

Pet No 1

Name / Nombre*
Birth Date*
Neutered / Castrado*
Last Vaccination Date*
Last Date Rabies*
Add another pet for this visit?

Pet No 2

Name / Nombre
Birth Date
Neutered / Castrado
Last Date Rabies
Last Vaccination Date
List Names and Types of Any Other Pets You Own
Reason for Visit*

I hereby authorize the veterinarian and his/her assistants to examine, prescribe for, or treat the above described pet(s). I assume responsibility for all charges incurred, in the care of this animal. The nature of such services has been described to me, to my satisfaction, and while I expect all procedures to be done to the best abilities of the professional staff, I realize that there is no guarantee or warranty that can be ethically or professionally made regarding the results or cure. I understand that I will not receive a refund on any type of medication and/or vitamins. I also understand that these charges will be paid at the time of release and that a deposit may be required for a surgical treatment. I understand that Miami Animal Clinic may not be present overnight, only during office hours.

I agree*
Today's Date:*

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  • Miami Animal Clinic
  • (786) 542-6070
  • 7337 SW 8th St, Miami, FL 33144
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