Client Information Update Form

Client Information Update Form

  • For Office Use Only

    For Office Use Only
  • Enter all 0s if you do not have one
  • Enter all 0s if you do not have one
  • Enter all 0s if you do not have one
  • Please list current pets in your household:

  • To prevent the spread of infectious diseases and parasites, hospitalized and boarded pets must be current on all vaccines. It is our policy that payment is due at the time of service. We will gladly prepare a written treatment plan upon request. A deposit may be required for all new clients or hospitalized patients. I authorize the doctors on staff at Chickasaw Trail Animal Hospital to examine, treat, prescribe for, or operate upon my pet and I understand that all reasonable precautions will be taken again injury, escape, or death. I understand if this account is assigned to a collection agency an additional fee of 30% of the amount owed will be added. Balances over 30 days will accrue finance charge at 1.5% monthly.
  • Date Format: MM slash DD slash YYYY
  • We think your pet is PAWS-itively perfect and want everyone to know! By signing this waiver I give Chickasaw Trail Animal Hospital the right to use the photo(s) and name(s) of my pet provided for reproduction in any promotional medium including but not limited to; website, video, broadcast, print, and electronic means for purposes of advertising, trade, display, exhibition or editorial use. Further, you also (i) agree to release Chickasaw Trail Animal Hospital from all claims for libel, slander, invasion of privacy, infringement of copyright or right of publicity or any other claim and (ii) confirm that you are over the age of 18 years old.

In the News

Location Hours
Monday8:00am – 6:00pm
Tuesday8:00am – 6:00pm
Wednesday8:00am – 5:00pm
Thursday8:00am – 6:00pm
Friday8:00am – 6:00pm
Saturday8:00am – 12:00pm

In case of emergency: Veterinary Emergency Clinic - Waterford Lakes - 11011 Lake Underhill Rd. Orlando 32825 407-644-4449 Veterinary Emergency Clinic - Casselberry 195 Concord Dr. Casselberry 32707 407-438-4449