CLIENT REGISTRATION FORM






Please fill out the registration form below and submit before your scheduled appointment. As an alternative, you can download our form and fax it/mail it before your appointment.

Client Information




















Primary PhoneWork PhoneEmergency PhoneSpouse PhoneEmail

Pet Information




CatDog


YesNo



Should at any time, my pet become unstable while under the care of VSC Sarasota and require cardiopulmonary resuscitation (CPR), I request or decline such medical intervention as indicated below.

By selecting for these life-saving measures to be made, I agree to be held responsible for all charges incurred for these treatments until I can be reached for further consent to continue.

Request for CPRDecline CPR — DO NO RESUSCITATE MY PET

Payment Policy

We thank you for allowing us the opportunity to care for your pet. In order to continue to provide the highest standard of care for our patients at Veterinary Specialty Center of Sarasota, we require that all fees are due prior to discharge of your pet. We will provide you with a written estimate prior to admission and our medical team will review all charges with you before treatment is performed. At patient drop-off, a 75% deposit is required to cover the low estimate amount. The remaining balance on this account will be due before patient discharge. We will keep you well informed of your pet’s condition during their hospital stay at VSC as well as the remaining balance due.
For your convenience VSC accepts the following forms of payment: cash, personal check (with check funds verified at time of payment), credit card (Visa, MC, Discover, AMEX), and Care Credit. There will be a service charge issued to your account for any fees incurred for a returned check.

To confirm understanding of the payment policy, please carefully read and sign the payment policy before your pet is treated at VSC.

I accept this Payment Policy.





info@vscsarasota.com
941.893.1500
8033 Cooper Creek Boulevard,
        #101, University Park,
        Florida 34201

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