New Patient - AirHeart Pet Hospital JFK
718-917-8059
78A Old Rockaway Blvd
Jamaica, NY 11430
Stay Connected
Menu

New Patient Form

Client Information


Is this pet co-owned?

If yes, co-owner's relationship to you:

Patient Information

Is your pet a cat or a dog?

Which option below best fits your pet?

Is your pet microchipped?

If yes, please provide the number

To your knowledge, is your pet current on his or her vaccinations?

Do you have certification(s) of your pet’s latest vaccines?

If yes, please bring the certification(s) to your pet’s appointment. If no, please provide your pet’s previous veterinary hospital contact information.

How did you hear about us?

Payment Authorization

Payment must be rendered at the time of service. We accept all major credit cards including Care Credit. Personal checks are welcome when accompanied by a driver’s license. If you have any questions regarding your payment, please discuss it with a receptionist before the start of your pet’s visit.

I hereby authorize a veterinarian at AirHeart Animal Hospital to examine, prescribe for, or treat the above described pet. I assume responsibility for all charges incurred in the care of this animal.

Thank you for choosing AirHeart Animal Hospital for your pet’s healthcare.

Digital Signature:

Date: