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Shaffer Animal Hospital - New Client Form
Shaffer Animal Hospital - New Client Form
Please call our office to schedule an appointment prior to completing this form.
Shaffer Animal Hospital - New Client Form
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    Please call our office (407) 366-1722 to schedule an appointment prior to completing this form.

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    * I hereby authorize the person named as emergency contact to make all medical decisions in the event I am unable to be reached.
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    • Social Media
    • Google
    • Website
    • Referral
    • Drive By
    • Yelp
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    • Fear Free Directory
    • Other
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    As a Fear Free Certified Professional team, we want to make you pet’s veterinary experience as enjoyable and as stress free as possible. As such, it’s important for us to understand what your pet might find upsetting. The information will help us to adjust our care to better serve and comfort your pet. Please answer the following questions to the best of your ability so we can take into consideration both your & your pet’s preferences.

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    • Canine
    • Feline
    • Other
    • Male
    • Female
    • Spayed
    • Neutered
    • I don't know
    • No
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    Female Vet or Male Vet
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    • Canine
    • Feline
    • Other
    • Male
    • Female
    • Spayed
    • Neutered
    • I don't know
    • No
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    Female Vet or Male Vet
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    • Canine
    • Feline
    • Other
    • Male
    • Female
    • Spayed
    • Neutered
    • I don't know
    • No
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    Female Vet or Male Vet
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    • Canine
    • Feline
    • Other
    • Male
    • Female
    • Spayed
    • Neutered
    • I don't know
    • No
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    Female Vet or Male Vet
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    This will be used for their medical record and may also be used for social media
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    TERMS OF SERVICE:

    We accept cash, check, Visa, MasterCard, Discover, American Express, and Care Credit as forms of payment.

    We are committed to providing all of our patients with exceptional care. Due to a high demand for appointments, when a client cancels without giving advance notice, they prevent another patient from being seen. For this reason, Shaffer Animal Hospital and G.O.D.O.G.S. maintains a cancellation policy. In order to be respectful of the medical needs of other patients, we require all new clients to commit to a deposit in the amount of the exam fee to secure an appointment. We do understand that situations outside of your control arise and it is not always possible to give advance notice. Please be courteous and call or text our office promptly if you are unable to show up for an appointment, this time will be reallocated to someone who is in need of treatment.. The first time an appointment is cancelled or rescheduled with less than 24 hours notice, we will allow a one time courtesy. After the first rescheduled appointment, the deposit will be forfeit and an additional deposit will be required to schedule any future appointments.

    On your request, we will provide you with a written estimate of fees for any treatment or services we provide. Please note: these estimates are individually tailored and subject to
    change based on your pet(s)’ health. Every effort will be made to notify you of any updates as they arise if your pet is receiving ongoing treatment.

    I understand that FULL PAYMENT IS DUE AT THE TIME SERVICE IS RENDERED and that a DEPOSIT IS REQUIRED FOR ANY HOSPITALIZED PET. All unpaid balances are subject to a 1.5% per month interest charge. Returned checks are subject to the incurred returned check fee. In the event legal action is required to recover an unpaid balance, I agree to pay all interest, court costs and attorney’s fees.

    All information I have provided here is true to the best of my knowledge. I have read and understand the Terms of Service.

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