Client Registration

Please fill out completely. It may be necessary at some time to contact you concerning needed treatment or the progress of your pet, and this information can save us valuable time. Some of the information is also necessary in order to accept checks for payments. Thank you.

You may also download and print the form. 


Avian Form Avian Form

AVIAN & MAMMALS

PAYMENT FOR SERVICES DUE WHEN RENDERED

Identification necessary in order to accept checks and credit cards. Nearest relative not living with you:

---------------PATIENT INFORMATION-----------------

Recent Changes in:

I grant Exotic bird hospital and any and all its subsidiaries full permission to use any and all images taken of me or my pets for the sole use of education, advertisement and promotion. This includes but is not limited to Facebook, Twitter, Youtube videos and other Social media sites, websites blogs and website display. I certify that I am 18 years of age or older.

Reptile Form Reptile Form

REPTILES

PAYMENT FOR SERVICES DUE WHEN RENDERED

Identification necessary in order to accept checks and credit cards:

Nearest relative not living with you:

---------------PATIENTE INFORMATION----------------

I grant Exotic bird hospital and any and all its subsidiaries full permission to use any and all images taken of me or my pets for the sole use of education, advertisement and promotion. This includes but is not limited to Facebook, Twitter, Youtube videos and other Social media sites, websites blogs and website display. I certify that I am 18 years of age or older.

11744 Beach Blvd, Jacksonville Fl 32246 PH: (904)256-0043