Name: Integrative Animal Hospital of Central Florida
Address: 255 Orange Blvd., Sanford, FL, 32771, USA

Welcome to Integrative Animal Hospital of Central Florida! We ask our new clients to provide a valid credit card to secure your upcoming appointment due to our highly limited availability. This information will only be used to charge your credit card a non-refundable $59 cancellation fee if you cancel your appointment less than 24 hours prior to your scheduled appointment time. Please fill out our credit card authorization form and return it to our office to guarantee your appointment. Please don’t hesitate to call us if you have any questions. Thank you for trusting us with your pet’s healthcare!
Name of card holder:*
First name Last name
I authorize the below person to use my credit card for payment of services rendered by Integrative Animal Hospital of Central Florida.*
First name Last name
Pet’s Name*
Amount authorized: $*
Please call the hospital at 407-833-8868 to provide payment method details over the phone.
Contact phone number:*
Contact Fax number:
Date*
MM slash DD slash YYYY
Signature of card holder*