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 $135.00 consultation fee that is due at the time of service. I understand that a deposit of 75% 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.)
 
I grant to Affiliated Veterinary Specialists, its representatives and employees the right to take photographs of me and/or my pet, and to copyright, use and publish the same in print and/or electronically.
 
I agree that Affiliated Veterinary Specialists may use such photographs of me and/or my pet with or without my name and for any lawful purpose, including, for example, such purposes as publicity, illustration, advertising, and Web content.