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  • Comprehensive Veterinary Dermatology in Orange Park and Jacksonville

New Patient Form

Please fill out our New Patient Form using one of the options below if your pet is a new patient at Animal Friends Dermatology.

Option 1

Complete Online

Complete and submit the online form below.

Option 2

Print & Complete

Bring the completed form with you to our hospital.

Download Form

Option 3

Complete on Arrival

If you prefer, fill out the form when you get to our hospital. Please make sure to arrive 10 minutes early.

New Patient Form

Owner Information

Emergency Contact

Patient Information

Primary Veterinarian Information

By listing your primary care veterinarian, you are authorizing Animal Friends Dermatology to release patient information to the primary care hospital or veterinarian.

Tell Us About Your Pet's Skin/Ear Issue

Authorizations/Release

Payment & Missed Appointments

By submitting this form, I hereby authorize Animal Friends Dermatology to render medical care for my pet(s) as deemed necessary by the veterinarian. I understand that no guarantee can be given to the outcome of treatments and take it as my responsibility to comprehend any risks involved. I understand that payment is expected in full at the time services are rendered, and assume full financial responsibility for all diagnostic and therapeutic procedures. I agree to make full payment for all services with cash, check, Visa, Mastercard, Discover, Care Credit or American Express. I agree to pay reasonable attorney’s fees and collection cost should collection become necessary.
By submitting this form I agree that I understand that Animal Friends Dermatology has the right to charge for canceled or broken appointments without 24 hours advance notice $65 for New patient appointments, $30 for Re-evaluation appointments, and $150.00 for Procedure appointments.

New Patients Welcome

Animal Friends Dermatology is accepting new patients! Get in touch today to book your pet's first appointment.

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