Pre-Registration Form

To pre-register your pet(s) with SWFVS, please fill out the form below. It will automatically be submitted via email. Please call us at 239-992-8387 with questions, to verify that your pre-registration form was received, or to securely keep your credit card information on file. We are here 24/7/365 to handle your pet’s emergent needs. If registering more than three pets, please call our office to register by phone.
  • Client Information

  • Your email address will not be shared with any third party
  • Your Pet's Information

  • Treatment Authorization & Payment Information

    I am the owner, or agent of the owner, of the above-described and have the authority to execute this agreement. I authorize Southwest Florida Veterinary Specialists to examine and treat the above pet. I accept full financial responsibility for the pet and understand that payment is due at the time of services. For hospitalized cases, a deposit is required in advance. The balance is due upon discharge from the hospital. If another veterinarian has referred me to SWFVS, I understand that they will receive a summary of the care and treatment provided by SWFVS to ensure that my pet’s care can be continued without interruption. I also understand that SWFVS considers the identification of a referring veterinarian by me to be my authorization to release records and information to that veterinarian.
  • We at SWFVS understand that this may be a difficult time for you and your pet. We realize a visit to our hospital in unplanned and the associated fees are unexpected. We offer the following options to assist you: Cash Cash payments are gladly accepted. Personal Checks (No Business Checks) We accept personal checks only with a current driver’s license. When you provide us with a check as payment you authorize us to either use information from your check to make a one-time electronic fund transfer from your account or to process the payment as a check transaction. Credit Cards All major credit cards accepted. CareCredit Care Credit is a credit card dedicated to health care. It involves a no cost application, which can be processed in-house at no cost to you. We offer a six month no interest payment plan. For further information on Care Credit please contact our office.
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