New Client Form

 Client Information

 Pet Information

 Referring Veterinarian

Ophthalmic History

At the veterinarian’s office, is your pet typically calm and relaxed or are they fearful and anxious? We would like to make your visit as pleasant as possible, most importantly for your pet. Please describe anything that we may need to know about your pet’s personality. By having a better idea of your pet’s personality, we can tailor the exam and interaction toward comfort and associating positivity with our clinic.

Photo Consent Form

Gulf Coast Animal Eye Clinic strives to educate clients, veterinary professional, and students on ocular diseases. Photographs and videos of ocular disease have proven to be most helpful in documenting progress and outcomes. Pictures and/or videos of your pet’s eye(s) would aid in educating as well as documenting the progress of your pet’s ocular issues. Your name and your pet’s name will not be used in order to keep information private.

In signing this consent, I hereby grant Gulf Coast Animal Eye Clinic permission to use any photographs and/or videos taken of my pet, in any and all of its publications, including the website entries, without payment or any other consideration. I understand and agree that these materials will become the property of Gulf Coast Animal Eye Clinic and will not be returned. 

I hereby authorize Gulf Coast Animal Eye Clinic to edit, alter, copy, exhibit, publish, or distribute this photo and/or video for purposes of publicizing their programs or for any other lawful purpose. In addition, I waive any right to royalties or other compensation arising or related to the use of the photograph. I hereby release Gulf Coast Animal Eye Clinic from all claims, demand, and causes to action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf of my estate have or may have reason of this authorization.

Cancellation and No-Show Policy

We understand that situations arise in which you must cancel your pet's appointment. Missed appointments, or appointments not canceled in an appropriate amount of time, hinder our ability to help other patients in need. We ask that you make every effort to keep your scheduled appointment and to

arrive on time. If you're running behind, please give us a courtesy call and we will make every effort to work your pet back into the schedule.

No-show refers to appointments that are canceled with less than 24-hour notice or clients who do not bring their pet at the scheduled appointment time. No-show appointments are subject to a $30.00 fee. We understand that unavoidable circumstances arise and may cause you to cancel within 24 hours. Fees in these instances may be waived.

By signing below you indicate that you have read, understand, and agree to this policy.

Poliza de Cancelacion y No Presentacion

Nosotros entendemos que se presenten situaciones en las que debas cancelar la cita de su mascota. Las citas perdidas o las citas que no se cancelan en un periodo de tiempo adecuado dificultan nuestra capacida de ayudar a otros pacientes. Le pedimos que haga todo lo posible para cumplir con su cita programada y llegar a tiempo. Si se esta atrasando llamenos de cortesia y haremos todo lo posible para que su mascota se a vista.

No presentarse se refiere a citas que se cancelan con menos de 24 horas de anticipacion o clientes que no traen a sus mascota a la hora de la cita programada. Las citas por no presentarse estan sujetas a un cargo de $30.00. Nosotros entendemos que surgen circumstancias inevitables y pueden hacer cancelar dentro de las 24 horas. Las tarifas en estos casos pueden no aplicarse.

A firmar indica que ha leido, comprendido y acepta esta poliza.