DOWNLOAD FORM HIALEAH ANIMAL CLINICWELCOMEWelcome to HAC. Thank you for giving us the opportunity to care for your pet. We will be happy to answer any questions you may have about your pet’s health. Here at HACour mission is to provide your best friend with our verybest loving, compassionate veterinary healthand wellness care from before hello to beyond good-bye. To ensure the best care possible, please take the time to fill out this form. NO ABRIR EXPEDIENTES A MENORES DE EDADNOTE: DO NOT OPEN FILES FOR MINORSOwner/Dueño First Name/Primer Nombre Middle Name/Segundo Nombre Last Name/Apellido Address Street Address City State / Province / Region ZIP / Postal Code Phone*Emergency Phone*Spouse or Co-Owner's Name First Last Spouse or Co-Owner's PhoneReferred ByONLY FOR CLINIC PURPOSES: Email* Please check here if you give us permission to put your pet’s pictures on our Facebook. Yes No PET No1 First Microchip #Birth Date MM slash DD slash YYYY Untitled Dog Cat Sex Male Female ColorNeutered / Castrado Yes No Last Date Vaccination MM slash DD slash YYYY Last Date Rabbies MM slash DD slash YYYY Vaccines up to DateAllergies - Long Term ProblemsMedicationsReason for Call Select All Exam Diarreah Coughing Sneezing Eating Problem Vomiting Other OtherPET No2 First Microchip #Birth Date MM slash DD slash YYYY Untitled Dog Cat Sex Male Female ColorNeutered / Castrado Yes No Last Date Vaccination MM slash DD slash YYYY Last Date Rabbies MM slash DD slash YYYY Vaccines up to DateAllergies - Long Term ProblemsMedicationsReason for Call Select All Exam Diarreah Coughing Sneezing Eating Problem Vomiting Other OtherI 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 inthe 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 thebest abilities of theprofessional 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 notreceive 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 requiredfor surgical treatment.I understand that Hialeah Animal Clinicmaynot be present overnight,only during office hoursEmailThis field is for validation purposes and should be left unchanged.
