Affiliated Veterinary Specialists - Jacksonville and Orange Park Veterinarians

Gainesville Location - Online Admission Form

If you would like to fill out our Online Admission Form, please complete the form below and click submit!

If you would prefer to print out our Admission Form and bring with you on your visit, click here.

Owner Information
 
 
 
 
 
 
 
 
 
 
Pet Information
 
 
 
 


 


 


 


 
 
 
 
 


 
Referral Information
 
 
 
 
I assume all responsibility for all charges incurred in the care of this animal. I understand that there is a $125.00 consultation fee that is due at the time of service. I understand that a deposit of 50% of the highest end of any surgical estimate given will be required before the treatment of my pet. I also understand that the bill must be paid in full at the time of release of my pet. (We may need to make a photo copy of your driver license for our chart.)