Appointment Information

  • Owner Information

  • Patient Information

  • Primary Veterinarian Information

  • I hereby affirm that I am the legal guardian of the above-described pet. I fully understand that no guarantee of successful treatment is made and will not hold Florida Veterinary Referral Center or its employees liable for any consequences directly or indirectly related to all services provided. I am fully aware that all charges for services provided are my responsibility. I agree to pay all charges incurred by my pet at the time of his/her release. Failure to communicate with the staff at FVRC for more than 2 days without prior arrangements will be considered abandonment of my pet. Any abandoned animal will be handled by the hospital according to state regulations. Late payments are subject to a late charge of 1.5% each 30 days or less. All collection cost and reasonable attorney’s fees are my responsibility.

    I also hereby authorize Florida Veterinary Referral Center to release my pet’s medical records to myself and to my primary veterinarian(s).

    By submitting this form, you are agreeing to Florida Veterinary Referral Center's terms and conditions listed above.


Request Medication Refill

  • Once your request has been submitted you will be contacted within 24 hours. (Monday-Friday)
    If you are submitting this form on a weekend (Sat-Sun) your prescription will not be filled until the following Monday. If you need your refill sooner please call our hospital and we will be happy to assist you.
    Note: Florida Pharmacy Law requires that all pets have a current doctor patient relationship. Please feel free to contact us with questions.
  • Medication Details

  • (Ex: 1/2 tablet twice a day.)
  • (Ex: 30 tablets or 1 month supply etc.)
  • (If not at FVRC, please list the name of the pharmacy, location and phone number.)




Client Survey

  • In order to provide you and your pet with exceptional service and care, the doctors and staff of Florida Veterinary Referral Center would like to hear from you. Please tell us how we are doing by completing this form. Thank you for allowing us to serve you!
  • Date Format: MM slash DD slash YYYY
  • Drop files here or
    Accepted file types: jpg, png, jpeg.


Doctor Survey

  • In an effort to provide you and your clients with exceptional service and attention, the doctors and staff of Florida Veterinary Referral Center would appreciate your input. Please tell us how we are doing by completing this survey and submitting it.

    Thank you for allowing us to serve you with your patient's needs.