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Today:
8:00 am - 6:00 pm
Open Hours
(561) 798-5508
Phone Number
11462 Okeechobee Blvd
Royal Palm Beach, FL, 33411
Request an Appointment
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today:2023-03-29
New Client
Welcome! Prior to your pets upcoming appointment, please fill out the form below.
Your Name
*
Your Phone
*
Today's Date
*
Your Email
*
Your Address
*
Employer
Employer Address
Occupation
Drivers License Number
Co-Owner/Emergency Contact
*
How did you first hear of our hospital?
*
AAHA Referral
Hospital Sign
Website
Town Crier Article
Social Media
Family/Friend
Other
If friend, family or other, please explain here.
Pet #1 Info
Pet Name
*
Species
Canine
Feline
Other
Breed & Color
*
Estimated Age (or Date of Birth)
*
Sex
Female
Female Spayed
Male
Male Neutered
What do you feed your pet?
*
Do you give heartworm preventative?
*
Yes
No
If yes, what kind?
Is your pet on any medications?
*
Yes
No
If yes, list the name and dosage
Do you give vitamins or supplements?
*
Yes
No
If yes, what kind?
Please list any previous illnesses or surgeries and the dates.
*
Pet #2 Info
Pet Name
Species
Canine
Feline
Other
Breed & Color
Estimated Age (or Date of Birth)
Sex
Female
Female Spayed
Male
Male Neutered
What do you feed your pet?
Do you give heartworm preventative?
Yes
No
If yes, what kind?
Is your pet on any medications?
Yes
No
If yes, list the name and dosage
Do you give vitamins or supplements?
Yes
No
If yes, what kind?
Please list any previous illnesses or surgeries and the dates.
All information collected is confidential and will not be shared without your written consent. We will gladly prepare a written estimate if you desire. Please ask the receptionist or doctor. Professional fees are due at the time services are rendered. Payment methods accepted include Cash, Credit Cards, and Care Credit. We do not accept personal checks. 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 the release of the pet.
I give Community Animal Hospital of RPB permission to post photos of my pet(s) on their website or social media channels.
*
Yes
No
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