Name: Partridge Animal Hospital
Address: 6400 4th Street North, St. Petersburg, FL, 33702, USA

Please complete the form below, or you may print out the forms HERE and bring them with you for your pet’s appointment.

Owner Information
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Primary Phone*
Type of Phone
Secondary Phone
Type of Phone
Email*
Add a second owner?*
- Yes
- No
Secondary Owner Information
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Primary Phone*
Type of Phone
Secondary Phone
Type of Phone
Email*
Pet Information
Pet name*
Species*
- Dog
- Cat
Breed*
Color markings*
Date of birth or age*
Sex*
- Male
- Female
Spay or neutered?*
- Yes
- No
History*
Add a second pet?*
- Yes
- No
Pet name*
Species*
- Dog
- Cat
Breed*
Color markings*
Date of birth or age*
Sex*
- Male
- Female
Spay or neutered?*
- Yes
- No
History*
Add a third pet?*
- Yes
- No
Pet name*
Species*
- Dog
- Cat
Breed*
Color markings*
Date of birth or age*
Sex*
- Male
- Female
Spay or neutered?*
- Yes
- No
History*
I grant permission to Partridge Animal Hospital to take photographs and/or video of me and/or my pet(s), to copyright, use and publish the same in print and/or electronically. Partridge Animal Hospital may also use and publish my pet's story, including relevant medical history. I agree that Partridge Animal Hospital may use such photographs, videos or stories including me and/or my pet with or without our names and for any lawful purpose, including for example such purposes as social media, publicity, advertising, and other Web content.*
- Yes, I consent.
- No, I do not consent.
How did you hear about us?*
- Personal Referral
- Another Hospital
- Website
- Facebook
- Google
- Sign
- Other
Whom may we thank?
Name of Hospital
Other
Financial Policy Agreement
Click here to view our Financial Policy Agreement
Thank you for choosing Partridge Animal Hospital. Our primary mission is to deliver the best and most comprehensive veterinary care available for your pet. An important part of the mission is making the cost of optimal care as easy and manageable for our clients as possible by offering several payment options. Partridge Animal Hospital requires payment in full at the end of your pet’s examination and/or at the time of discharge.

Payment Options:
You can choose from:
- Cash/check, Visa®, MasterCard®, Discover Card®
- Convenient Monthly Payment Options¹ from the CareCredit® Healthcare CreditCard and Scratchpay
Deposit & Billing:
For some treatments or hospitalized care, a deposit may be required. Healthcare plans requiring comprehensive care will require a 50% deposit to begin your pet’s treatment. We may offer in-house payment options on a case-by-case basis. We charge 1.25% interest on all outstanding account balances older than 30 days in addition to a $3.00 billing fee. If you have an account 120 days past due, Partridge Animal Hospital may relinquish your balance owed to a collection attorney.

Additional Policy Information:
Partridge Animal Hospital charges $40.00 for returned checks.

For clients with pet insurance, we are happy to provide you with the necessary documentation to submit a claim to your insurance carrier.

If you have any questions, please do not hesitate to ask. We are here to provide the best veterinary care available for your pet.

By signing below, you agree to the foregoing terms of payment:
*
- I have read and agree to the above financial policy agreement
Cancellation Policy Agreement
Click here to view our Cancellation Policy Agreement
Our goal is to provide excellent individualized medical care in a timely manner. “No shows” and late cancellations inconvenience clients and their pets who need access to medical care in a timely manner. We are instituting an office policy regarding missed appointments. This policy enables us to better utilize our appointments for our patients in need. We are proud of the quality time that we spend with you and your pet, and we also strive to run on time, but we need your cooperation in order to do so.

CANCELLATION OF AN APPOINTMENT: In order to be respectful of other clients and patients, please be courteous and call Partridge Animal Hospital promptly if you are unable to show up for an appointment so this time slot can be reallocated to another patient. If it is necessary to cancel your scheduled appointment, we require that you call at least 24 hours in advance. Appointments are in high demand, and your early cancellation will give another patient access to medical care.

We strive to see patients who arrive on time at their scheduled time. Patients who have arrived on time will be seen ahead of those who arrive late. If you arrive late for your appointment, we may need to abbreviate or reschedule your pet’s visit.

HOW TO RESCHEDULE YOUR APPOINTMENT:
To cancel or reschedule, please call (727) 5268700.

LATE CANCELLATIONS: A late cancellation is when an owner fails to cancel their scheduled appointment with a 24hour advance notice. Call us if you will be late or unable to make your appointment time. We will do all that we can to accommodate your pet’s appointment and to minimize the need to reschedule.

NOSHOW POLICY: A “Noshow” is a missed appointment without cancelling it in an adequate manner. Failure to be present at the time of a scheduled appointment will be recorded in your pet’s medical record as a “noshow.”
- First and second missed appointment there will be no charge, but a notation will be made in your pet’s chart.
- Subsequent missed appointments in order to make a future appointment, you will be required to make a prepayment of the exam/consultation charge of $63.00. If your next appointment is kept, this $63.00 will be applied to it. If it is missed, this becomes a nonrefundable fee.
*
- I have read and agree to the above cancellation policy agreement
Signature*
We will gladly prepare a written estimate upon request. ALL FEES ARE DUE AT THE TIME SERVICES ARE RENDERED. **A 1.25% MONTHLY INTEREST FEE AND $3.00 STATEMENT FEE WILL BE ASSESSED TO ALL PAST-DUE BALANCES. Undersigned owner/s agrees that Partridge Animal Hospital shall be entitled to recover its attorneys’ fees and costs incurred as a result of any past due balances.**

Owner Information

Secondary Owner Information

Pet Information

Financial Policy Agreement

Cancellation Policy Agreement