Ophthalmology For Animals Welcomes New Patients

New Patients Paperwork

We are excited to welcome you and your pets as new patients at Ophthalmology For Animals! Please fill our our New Patient Paperwork below.

Pet Owner Information

First Name(*)

Invalid Input

Last Name(*)

Please type your full name.

Spouse/ Partner/ Other Agents

Invalid Input

Street Address(*)

Invalid Input

City(*)

Invalid Input

State & Zip(*)

Invalid Input

Home Phone

Invalid Input

Work Phone

Invalid Input

Cell Phone

Invalid Input

Occupation

Invalid Input

Drivers License

Invalid Input

E-mail(*)

Invalid email address.

Primary Veterinarian/ Clinic(*)

Invalid Input

Please Tell Us About Your Pet(s)

Pet Name(*)

Invalid Input

Approximate Birth Date

Invalid Input

Cat/ Dog/ Other(*)

Invalid Input

Breed(*)

Invalid Input

Color(*)

Invalid Input

Sex(*)

Invalid Input

Spayed/ Neutered(*)

Invalid Input

Please briefly explain your pet's condition and the reason for your visit.(*)

Invalid Input

Will you be bringing in a second pet during your visit?(*)

No Yes

Invalid Input

Pet Name

Invalid Input

Approximate Birth Date

Invalid Input

Cat/ Dog/ Other

Invalid Input

Breed

Invalid Input

Color

Invalid Input

Sex

Invalid Input

Spayed/ Neutered

Invalid Input

Please briefly explain your pet's condition and the reason for your visit.

Invalid Input

Terms & Conditions

We value your bond with your primary veterinarian.  A referral to a specialist indicates your veterinarian’s concern for your pet.  Your veterinarian will be provided with a report of your visit to ensure continuity of care.  During your treatment with us, Ophthalmology for Animals cannot provide general veterinary care for your pet with the exception of emergency care.  The ophthalmologist will inform you of prognosis and anticipated recovery time.  In general, we recommend that you follow up with us for the presenting problem so we can accurately assess your pet’s progress and direct his/her recovery. 

In order to assure an optimum care provider-patient relationship, please comply with the following instructions:  
   
- Arrive promptly for your appointment time.  The time given is reserved just for you. 

- The office requires 24HOUR notice if you cannot keep your appointment or need to reschedule an appointment.  

If you do not give us a 24 hour notice this will be considered a failed appointment, which may result in a $50 failure fee which you must pay before another appointment is scheduled.

I, authorize Ophthalmology for Animals to request my pet’s medical records from my veterinarian and to release a report of ophthalmic findings to my veterinarian. I, the undersigned owner or agent of the owner, understand that payment is expected when services are performed. I will provide payment via cash, check, CareCredit, Visa, MasterCard, Amex, or Discover credit card.

Invalid Input

By checking "I Agree" you are agreeing to all Terms & Conditions detailed above(*)

I agree

You must click "I Agree"

Check Box(*)

Invalid Input

Covid 19 Ophthalmology for Animals - August 6, 2020 (Rx Form)

Veterinary care is an essential part of our community and we want to assure you that our hospital is open and will continue to provide services at this time. We also want to work with you and our staff to limit direct contact in order to focus on safety for everyone during this pandemic. Accordingly, we ask that you follow the below steps for the safety of all:

Upon arrival at the hospital, please remain in your vehicle and call us.
After receipt of the call, we will check you in as soon as possible from outside the hospital.
If you are at the hospital to pick up medication, please remain in your car outside the hospital and call the front desk. We will deliver your order to your car as quickly as possible.
If you are not feeling well or may be at risk of exposure to coronavirus, please ask a healthy friend or family member to transport your pet to the hospital on your behalf.
We will do our best to coordinate your visit from outside the hospital, including providing follow up instructions and taking payments.

Ophthalmology for Animals, Inc., we have various ways to help care for your pets without a trip or call to the hospital.

Home Delivery: medications, including prescriptions and refills, can be ordered by sending us an email or text
Email: your questions, concerns, prescription refills, and pictures. We will do our best to respond in a timely manner.

Our goal is to keep our essential services available to the communities we serve and be there for you and your pets. Thank you for your cooperation and for doing your part in helping to keep pets and people safe, and please don’t hesitate to call with questions.

We anticipate our phone lines will be busier than usual, and therefore, we appreciate your patience!