Referral Registration Form
Coral Springs Animal Hospital

We are so excited to meet you! We look forward to helping you and your pet with Coral Springs Animal Hospital veterinary care. We just need some information to get started.

Referral Registration Form


*Information will not be sold or shared for mass email purposes -for hospital use only
(not living with you):




You have been referred here by your Primary Care Veterinarian for emergency care and/or specialty care OR you were not directly referred but have indicated you will be returning to a Primary Care Veterinarian. Please be aware that we will only treat your pet’s present problem. For Primary Care, (i.e. wellness visits, vaccines, boarding, bathing, etc.) we will refer you back to your Primary Care Veterinarian for those services. Your cooperation is appreciated.

I have read and understand the Referral Policy.


ALL FEES FOR PROFESSIONAL SERVICES ARE DUE AND PAYABLE AT THE TIME SERVICES ARE RENDERED. It is our policy to provide you with a written estimate of fees if you wish, especially for any case where in-hospital or emergency care is necessary. A deposit prior to treatment is required. The balance is due at discharge. I agree, in the event that any amount becomes past due more than 30 days, I will pay interest thereon at 18% per annum (1.5% per month), plus a monthly billing charge of $5.00 from the date the charges were incurred. In the event it becomes necessary to collect fees through the services of an attorney or other collection agency, either prior to or at trial, I agree to pay all reasonable attorney’s fees and/or collection agency fees, and reasonable attorney’s fees incurred. I am the legal owner or the representative of the legal owner of the animal being presented for treatment, and I am over 18 years of age. Notwithstanding anything to the contrary above, if this Agreement is being signed by an Agent of the Authorized Person (for example, a pet sitter or pet transporter), it is agreed and understood that such Agent is NOT responsible for any fees related to the care and treatment of the pet. Only the Authorized Person and/or Co-Owner is responsible for such fees.

I have read and understand the Payment Policy.