Live Oak Animal Hospital
Old Dixie Highway SW, Vero Beach, FL 32962
Phone: (772) 770-4263 Fax: (772) 778-4571
New Client/Patient Form
Welcome to the Live Oak Family! 
Please provide the following information so that we can make sure your pet's appointment runs smoothly.
New Client (Owner) Information:
(With our Share the Care referral program, both of you will receive a $10.00 credit)
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.
In the event legal action is required to recover an unpaid balance, I agree to pay all interest, court costs, and attorney's fees.
I authorize the release of my pet's medical records to Live Oak Animal Hospital and hereafter waive the written release requirement pursuant to Florida code.
I hereby authorize the veterinarian to examine, prescribe for or treat the above-described pet(s). I assume responsibility for all charges incurred in the care of this animal. I also understand that these charges must be paid in full, at the time of release of the pet.
New Client Consent & Treatment Authorization
I, the undersigned owner, authorized agent of the owner, or Good Samaritan responsible for seeking veterinary care for any and all pets in my control brought to this facility, certify that I am over eighteen years of age and hereby consent to the examination of these pets by staff veterinarians at this veterinary practice.
I understand that there will be an examination performed, and I agree that after consultation with me, the hospital's doctors may prescribe medication for and treat my pet(s).
I also hereby give the doctors at Live Oak Animal Hospital my permission to perform diagnostic procedures and treatments as are reasonably necessary to treat the conditions related to the visit(s).
I accept that all procedures will be performed to the best of the abilities of the staff at this hospital. I understand that veterinary medicine is not an exact science and that no guarantee or warranty has been made regarding the results that may be achieved.
I understand that I assume financial responsibility for all services rendered, and that payment is due when services are rendered. All unpaid balances are subject to a 1.5% per month interest charge. In the event that legal action is required to recover an unpaid balance, I agree to pay all interest, court costs, and attorney's fees.
I understand that if I pick up my pet(s) any later than the posted time of closure of the business, I may be subject to a late/boarding fee. I agree that if I fail to pick up my pet(s), this practice may handle this abandonment in the best interests of the pet(s) and the hospital, and I will be responsible for all fees incurred.
