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Wellness Intake Form
Client Contact Information
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First Name
Last Name
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Due to our new protocols aimed at reducing the possible spread of disease, we require that all clients provide a valid email address. This is where all documents and records will be sent, such as receipts, vaccine records, release forms, vaccine reaction sheets, and other important documents. If you do not have an email address, please create one before filling out this form.
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Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Pet Information
IMPORTANT: A separate Wellness Intake Form must be completed for each pet.
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Your pet's appointment date will have already been provided to you by the St. Augustine Humane Society staff. SELECTING A DATE ON THIS FORM DOES NOT MEAN YOU NOW HAVE AN APPOINTMENT. If you do not have an appointment date, please call us at 904-829-2737 or email info@staughumane.org to schedule an appointment.
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Please check all that apply.
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WELLNESS CARE IS PROVIDED TO HEALTHY ANIMALS. IT IS IMPORTANT FOR PET OWNERS TO HAVE A RELATIONSHIP WITH A FULL-SERVICE VETERINARIAN IN ADDITION TO THE SAHS CLINIC. FOR AFTER HOURS MEDICAL EMERGENCIES, CALL THE ST. AUGUSTINE REGIONAL VETERINARY CENTER, WHICH IS A FEE-BASED CLINIC AND YOU MUST PAY FOR THEIR SERVICES.

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I understand that the St. Augustine Humane Society may take pictures of my pet and share my pet's story to use in marketing and fundraising materials. No sensitive information about clients or pets will be released.
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Prefix
First Name
Last Name
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