Intake Form

VitalWell New Client Form — Native

Owner Information

Patient Information

Medical History of Animal (include diet and vaccine history)

Holistic Medicine Disclaimer

I understand that holistic and integrative therapies may complement but may not always replace conventional veterinary care, and that some therapies may not have FDA approval or traditional veterinary endorsement. Our team will work with you to create a balanced and informed care plan best suited for your pet’s individual needs.

Client Information & Financial Agreement

By signing below, I confirm that the information provided is accurate and understand that:

  • A veterinarian-client-patient relationship is not established until my pet is examined by a VitalWell veterinarian.
  • I am responsible for notifying VitalWell of changes to my contact information, pet's health, or ownership.
  • Payment is due at discharge. I accept financial responsibility for services provided, and payments are non-refundable once services are rendered or products are purchased, ordered, or dispensed.
  • Deposits are non-refundable and are applied toward the scheduled service or, when applicable, the examination or evaluation performed. Deposits are forfeited for cancellations or missed appointments.
  • I understand my right to receive a written prescription for medication that can be filled by the pharmacy of my choice or by my veterinarian, as provided in s. 474.224, Florida Statutes.

By signing below, I acknowledge that I have read, understand, and agree to the above.