St. Augustine Humane Society New Client Form

PLEASE NOTE: This form is NOT intended for serious injuries or medical emergencies. If your pet needs immediate assistance, please contact your full-service veterinarian.

DAYS OF OPERATION
Monday through Friday
9:00am to 4:00pm with an hour break from 12:30pm to 1:30pm

SURGERY DAYS
Tuesday and some Thursdays
Check in is 8:00am to 8:30am

WELLNESS CLINIC
Wednesday and Thursday and Friday

The St. Augustine Humane Society is a WELLNESS and SPAY/NEUTER clinic. By requesting to be our patient, you agree to follow the vaccination and spay/neuter recommendations from our staff veterinarians. Due to the volume of requests, please be patient with our staff. We will call and/or email as soon as we can. Please add "904-829-2737" to your phone as a contact to not miss a return call from us and "904-822-3688" to not miss a return text.

DOG OWNERS requesting SURGERY: Attaching vaccine records will expedite scheduling their surgery. We can provide clinic appointments if your dog is unvaccinated prior to their surgery date.

Owner's Information

Owner's Name *

First Name

Last Name

Phone Number *

This phone number is a *

Cell Phone

Home Phone

Other

Email *

Verify Email *

Address *

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Have you been to our clinic before? *

Yes

Pet Information

Pet's Name *

Species *

Dog

Cat

Breed *

Dogs = if mixed, what breed mix? Cats = Long or short hair?

Color *

Is pet spayed/neutered? *

Our clinic requires pets to be spayed/neutered to remain a patient.

Yes

Don't Know

I understand and agree to spay/neuter my pet to remain a patient. *

Will also need to initial even if your pet is already spayed/neutered.

Reason for Visit *

If your pet is receiving services being paid for by a rescue group, please list the rescue here.

What food are you feeding? *

Health history/medications pet is currently on? (including heartworm and flea medicine/prevention) *

Second Pet's Name *

Second Pet's Species *

Dog

Cat

Second Pet's Breed *

Dogs = if mixed, what breed mix? Cats = Long or short hair?

Second Pet's Color *

Is second pet spayed/neutered? *

Our clinic requires pets to be spayed/neutered to remain a patient.

Yes

Don't Know

I understand and agree to spay/neuter my pet to remain a patient. *

Will also need to initial even if your pet is already spayed/neutered.

Second Pet's Reason for Visit *

If your pet is receiving services being paid for by a rescue group, please list the rescue here.

What food are you feeding the second pet? *

Health history/medications second pet is currently on? (including heartworm and flea medicine/prevention) *

Third Pet's Name *

Third Pet's Species *

Dog

Cat

Third Pet's Breed *

Dogs = if mixed, what breed mix? Cats = Long or short hair?

Third Pet's Color *

Is third pet spayed/neutered? *

Our clinic requires pets to be spayed/neutered to remain a patient.

Yes

Don't Know

I understand and agree to spay/neuter my pet to remain a patient. *

Will also need to initial even if your pet is already spayed/neutered.

Third Pet's Reason for Visit *

If your pet is receiving services being paid for by a rescue group, please list the rescue here.

What food are you feeding the third pet? *

Health history/medications third pet is currently on? (including heartworm and flea medicine/prevention) *

Additional Pets to sign up

Please list additional pets to sign up.

Additional Pets

List by Name/Age/Breed - we will discuss further when we contact you to schedule.

If you have more than three pets who need an appointment, please email Chantelle at cbessett@staughumane.org with the following information for any additional pets:

Pet's Name
Species
Breed
Color
Approximate Age
Pet's Sex
Is pet spayed/neutered?
Approximate Weight
Reason for Visit
What food are you feeding the pet?
Health history/medications pet is currently on?

Vaccination Records

If you have a copy of your pet's vaccination records, please upload them here. If not, please have the records emailed to Chantelle at cbessett@staughumane.org. All DOGS must be fully vaccinated prior to surgery. We can provide a clinic appointment prior to surgery if your dog is not up to date. Cats may receive vaccines at time of surgery. Annual vaccines for cats include: FVRCP and Rabies Vaccines. Annual vaccines for dogs include: Da2PP and Rabies Vaccines. Rabies vaccines are required by law for pets over 12 weeks of age.

Vaccination Records (additional copies)

If you have additional copies of your pet's vaccination records, please upload them here.