New Client Form"*" indicates required fields Why Choose Us? Our mission is to provide your pet with a calming environment where the highest quality medical care and customer service are provided by a compassionate and knowledgeable staff. The doctors and staff at West Villages Animal Clinic aim to exceed your expectations and will treat every pet like one of our own. We understand the special bond you have with your pet is unlike any other. We are here to help you fully understand your pet’s healthcare needs so your pet can live its best life. Our practice philosophy is that an ounce of prevention is worth a pound of cure. State-of-the-art medical care will be provided following evidence-based medicine and research, with the most up-to-date equipment available. We wish to be in a mutually exclusive partnership with you, in order to provide a lifelong relationship with your pet. This relationship must be built on open communication, mutual respect, honesty, and trust from both parties in following medical recommendations. During your visits, expect to be greeted by a courteous receptionist, clean exam rooms, friendly veterinarians, and caring technicians/assistants. Our team members all have extensive veterinary experience (on average, over 14 years each) and all attend frequent continuing education with the common goal to follow the most recent medical guidelines. Appointments are not rushed, and ample time is spent getting to know you and your pet(s). Our focus is to provide preventative care, advanced care for illness, chronic disease management, dentistry, and soft tissue surgeries. While we do provide vaccinations for our patients, we are NOT a vaccination clinic. Preventive care is defined as a thorough annual wellness examination and consultation, annual comprehensive lab work (CBC, chemistry, urinalysis, heartworm, tick screening), monthly parasitic presentation, frequent dental prophylactic care, referrals to veterinary specialists when indicated, and a customized vaccination plan based on lifestyle. If this sounds like a good fit for your family, please answer the questions below for our review. Upon review, if it seems like our goals are similar to your expectations, we will reach out to schedule an appointment. Please provide as much detail as possible for the following questions:What are your healthcare goals and expectations for your pet(s)?*Rank the following in order of importance with (1) being most important and (5) least important to you.Pricing*Proximity*Availability*Mutual trust/exclusive relationship*Recommendations to provide the highest standard of quality care*When your pet(s) are sick, what are your expectations for care?*List your pet’s heartworm and flea/tick prevention and frequency of administration. If not on prevention, share the reasons why.*Do you have Pet Insurance? If so, with what company.*Has your pet had an anesthetic dental procedure? If yes, how was the experience? If no, why not?*What are your feelings on veterinary technicians communicating and answering medical questions directly to you on behalf of the veterinarian’s recommendations that you may have for your pet(s)*While we schedule on an appointment basis, we strive to be available for our patients during urgent care or emergency illnesses. If your pet encounters an emergency, beyond a physical examination, diagnostic testing is almost always fundamental in determining the severity of an illness, a treatment plan as well as a prognosis. The medical recommendations and prices will be explained and provided at every visit. If your pet has urgent health concerns that require immediate care, are you comfortable discussing your expectations and financial concerns openly and honestly with our team?* Yes No **Please forward medical records from all previous veterinarians immediately to firstname.lastname@example.org. Thank you for your time and consideration in allowing West Villages Animal Clinic to become a partner for your family’s veterinary care. We will review all information and based on your responses, we will reach out to you to schedule an initial examination and consultation.Please tell us how you chose our clinic:* I was referred by __________ Website/Facebook/Instagram page Previously a client of Dr. Daniels Location/Drive-byI was referred by:*Owner InformationOwner Name*Spouse/Partner NamePrimary Phone*Secondary PhoneEmail Address*Local Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Permanent Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Employer*Job Title*Pet Information*NameDate of BirthSpeciesBreedColorSexMicrochip#Spayed or Neutered Add RemovePrevious VeterinarianPhone NumberDo you consent that we contact your previous veterinarian to obtain medical records?* Yes NoCommunication PreferencesWhat is your preferred method of communication from us?* Text Email Call MailDo you agree to receive text message communications from us?* Yes NoDo you agree to receive email communications from us?* Yes NoDo give permission to use photographs or videos of your pets in social media?* Yes No Return policy: Over-the-counter, unopened, non-perishable merchandise may be returned within 14 calendar days with an original receipt. Prescription medication is legally prohibited from being resold in the state of Florida. Therefore, all prescription medication is non-refundable. Financial Policy: Payment is due at the Ame services are rendered. An estimate (verbal or written) will be provided prior to service. The bill may be more or less than estimated due to unforeseen factors or changes in the patient’s condition. I agree to pay the final bill, in full, at the Ame services are rendered. West Villages Animal Clinic does not accept checks. We do accept Cash, Visa, Mastercard, Discover, American Express, and Care Credit. I certify that I am the owner and/or agent of the above animal and have the authorization to consent to treatment if and when it is needed.Date* MM slash DD slash YYYY Signature*Printed Name*EmailThis field is for validation purposes and should be left unchanged.