New Patient Form

Welcome to Miami Veterinary Specialists. In preparation for your pet’s upcoming appointment, please fill out the New Patient Form below.

Owner / Client Information
Owner’s First and Last Name*
Telephone Number*
Type*
Secondary Contact’s Name
Telephone Number
Type
Address*
Street Address Address Line 2 City ZIP Code
Email*
Driver’s License or State Issued ID Number*
Patient / Pet Information
Pet’s Name*
Canine / Feline*
Breed
Breed
Sex*
Spayed*
Neutered*
Date of Birth / Age*
Color / Markings
Primary Veterinarian*
Hospital Name*
Reason for Visit*
Other
How did you hear about us?
May MVS use photos and videos of your pet for Marketing and social media purposes?*
In the case your pet was to suffer cardiac and/or pulmonary arrest, do you authorize us to provide life-saving measures?*
- Yes, I authorize life-saving measures. I understand that the cost of services may vary.
- No, I do not wish for life-saving measure to be employed. At this time, I am electing for a "Do not resuscitate" status of my pet.
Methods of Payments Accepted
American Express, Discover, MasterCard, Visa, Cash, Care Credit

We apologize for the inconvenience, but we DO NOT accept personal checks
Consultation Fees
Walk-in, After-hours and Weekends: $125 Internal Medicine: $200 Oncology: $175 Surgery: $175
I understand that only the primary and secondary contacts will receive diagnostic results and updates of the patient during hospitalization. I also hereby certify that the information provided above is true and accurate to the best of my knowledge.
Signature*
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Owner / Client Information