Client Registration Form for Exotic Pets

Booking an appointment for your exotic pet with us for the first time? Please complete this online form to help us get to know your companion and their unique health needs.

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Exotic Pets Registration Form

For exotic pet visits at Aaron Animal Clinic in Parma, please complete this form in advance. Sharing information about your pet’s species, habitat, and health history allows our team to better understand their unique needs and provide appropriate care.

Name *

First

Last

Spouse Name

First

Last

Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Primary Phone *

Secondary Phone

Pet's Name *

Species (reptile, bird, etc.) *

Color

Age:

Sex *

Male
Female

How long has this pet been with you?

Previous Vet:

Previous Owner or Place of Purchase:

Food / Prey Type(s) and amounts:

Live or pre-killed?

Diet variety / Alt. food / Prey types:

How is the pet offered food/prey?

Feeding schedule:

How is water made available and when:

Enclosure Type: (glass, hand-built, etc)

Please describe fully

Enclosure size:

Substrate used:

Heating Source (if applicable):

Lighting Used (if applicable):

Average Temp:

Daily & nighttime temp

Vita Bulb? (UVB lighting)

Decorations / Hiding used:

Water bowl or Pool size:

How many species in a cage?

What types/sizes?

is & that

Please tell us whom to thank for your referral:

Please select your preferred method of payment: *

Visa
Mastercard
Cash
Care Credit

Payment is due in full at the time that services are performed. If being admitted into the hospital, we cannot begin the care of your Pet until you have confirmed your desire to do so by 1) signing the client consent & estimate form, and 2) leaving an initial deposit of 50% of the upper end of the estimate. This is the only way that we have of knowing for certain that you want us to proceed with the care of your Pet. We accept Cash, Visa, MasterCard, Discover, and CareCredit payments. We neither extend credit, nor bill for services. All open invoices are sent to collections after 45 days unless prior arrangements are made. *

I have read and accept the financial policy.

Payment is due in full at the time that services are performed. If being admitted into the hospital, we cannot begin the care of your pet until you have confirmed your desire to do so by 1) signing the client consent and estimate form, and 2) leaving an initial deposit of 50% of the upper end of the estimate. This is the only way that we have of knowing for certain that you want us to proceed with the care of your pet. We accept Cash, Visa, MasterCard, Discover, and CareCredit payments. We neither extend credit, nor bill for services. All open invoices are sent to collections after 45 days unless prior arrangements are made.

Signature

Clear Signature

Date *

Message

Client Registration Form for Exotic Pets

Exotic Pets Registration Form

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