Please enter your information.

Primary owner's first name: *

First

Last

Address:

Address Line 1

Address Line 2

City

State

Zip Code

Mobile Phone: *

Home Phone:

Work Phone:

Email *

Name of co-owner: (Will have authority to make life altering decisions for pet)

Co-owner's Mobile Phone:

We use a text and email reminder system for your pets. You can stop the text reminders. The email reminders can be stopped by calling our office. We do NOT use post card reminders.

I understand and agree

Pet Information

Pet Name: *

Patient Species *

Canine
Feline

Patient's Breed

Date of Birth *

Age as of today:

How long have you owned pet for (as of today) *

Color:

Is your pet mostly indoor or outdoor? *

Is your pet around any other pets? *

How did you hear about us? *

Google
Social Media
Word of Mouth/Friend
Drive-by

Friend who referred you:

Previous Medical Care:

Name of last Veterinary Hospital or Clinic thet provided care for your pet: *

City and State of last Veterinarian:

Phone for last Veterinary Hospital or Clinic:

Last time your pet examined by a veterinarian: *

Who vaccinates your pet? *

Is your pet on medications or supplements? *

Is your pet allergic to medications or vaccines? *

Is your pet being actively treated for any medical conditions? *

Is your pet fearful or aggressive around strangers or vet hospitals? *

Has your pet had any reactions to vaccines? If yes, please explain: *

ESTIMATES:

An estimate will be provided by a technician after the doctor has examined your pet and had discussed their plan for treatment. At that time you can choose to accept or decline the treatments presented. Payment for services signed will be due at the time of services rendered. A 50% deposit of the estimate’s high end will be due at the time of drop off for drop off appointments. We do not provide over the phone estimates for sick or wellness visits.

I understand and agree

PAYMENT OPTIONS:

We accept cash, Visa, MasterCard, Discover, and American Express. We DO NOT accept checks. CARD HOLDER MUST BE PRESENT TO USE CARECREDIT, CREDIT OR DEBIT CARD.if a payment link has to be texted for payment service fee may apply.

I understand and agree

I, the undersigned, do hereby grant permission to Quail Meadow Animal Hospital to post my and/or my pet's photo or story, hereinafterr reffered to as "Memorials" on the hospital's website and social media account(s). I acknowledge and agree that no sums (i.e money) whatsoever will be due to me as a results of the use of these materials.

I agree
I declined and do not want my pet on the hospital's social media

REVIEWS AND SOCIAL MEDIA POSTINGS:

I understand that inappropriate, inaccurate, or untruthful reviews, comments, or posts about our practice, staff or/and services on Google, Facebook, any review site or social media platform will automatically result in termination of our patient-client relationship and termination of our services, If you have any concerns please direct them to our management who will work to resolve the issue.

I have read and agree

ONLINE PHARMACY AND PRESCRIPTION REFILL REQUESTS:

Please allow us a 24-hour period to refill medications. We will call you once these are ready to be picked up. Some medications must be specially ordered for your pet, these will take longer than 24 hours. Please call us prior to you current supply being depleted. You can go through our website or hospital app and submit a prescription request online. For those clients that use ONLINE PHARMACIES: Dr. Hernandez will give you a script for you to submit to the pharmacy of your choice. We do not sign prescriptions that are emailed, faxed, or approve them over the phone. On our website, we have a link to our own online pharmacy where we can guarantee the safety and efficacy of the product.

I have read and agree

RECORD REQUEST

If for any reason you require a copy of your records, please contact us for a copy. We will send you a free copy of your pet's records via e-mail. If you need a printed copy, please know there is a $0.25 per sheet printed/processed. All record requests can take up to 24 hours for processing.

I have read and agree

APPOINTMENT CANCELLATIONS & NO-SHOWS

Please be mindful that we are keeping appointment times specifically for your pet. This way we can assure that you and your pet get the attention and care they deserve. Please be advised there will be a no show fee and you will be required to pay a rebooking fee if you fail to show up for your pet's scheduled appointment or cancel with less than 24 hour notice. This policy applies for appointments booked for the same day as well, as these are limited spots per day. After three late cancellations and/or no shows we reserve the right to terminate future services.

I understand and agree

LATE ARRIVALS:

If you are more than 10 minutes late we will do our best to fit you in if the schedule allows, we reserve the right to cancel your appointment if we are unable to fit you in. A late cancellation fee may apply. Multiple late arrivals may result in termination of services.

I understand and greee

APPOINTMENTS & WALK-INS

We ask that you call us to make an appointment. Walk-in patients will be seen, but their wait may be longer as priority will be given to patients that have an appointment. The exam fee will also be different from normal appointments. If you believe your pet is in distress or has to be seen as an emergency please let our receptionist know.

I understand and agree

RECORDING NOTICE

I consent to the recording of audio and video during my interactions with the medical team at Quail Meadow Animal Hospital (QMAH). Recordings will be used for safety and medical transcription purposes. QMAH will take reasonable measures to protect the privacy and security of recorded information.

I understand and agree

e-Signature *

Clear Signature

By signing below, you acknowledge that you are 18yrs of age or older and understand the hospital policies on this document. By signing this form electronically, and clicking on "Submit Signature", you are agreeing to the terms stated herein.

If you have previous medical history files for your pet please upload them. Do not upload pictures of documents, files must be in PDF format.

Click or drag a file to this area to upload.

New Client Form

Please complete this form before your next visit.

High-quality veterinary care in Ocala, Florida.

Contact Quail Meadow Animal Hospital

Our Location

Our Hours

Contact Info