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New Client Form

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New Client Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit. We look forward to meeting you and your pet!
You can also download the form and email it to us by clicking the button below.

In Case of EMERGENCY:

Professional fees are due at the time services are rendered. Current Drivers license or California identification required for payments other than cash.

To help prevent the spread of infectious diseases, hospitalized patients must be current on FVRCP and Rabies. Vaccinations can be updated at the time of your appointment if they are not current.

I understand every effort will be made to achieve a successful outcome and to provide for all possible safety in hospital care and handling. I hereby authorize this hospital to receive, prescribe for, treat or perform surgery upon the pet(s) listed on the reverse side and additional pets I present. Furthermore, I agree to pay fees for services rendered at the time the pet is discharged from the hospital or the service is otherwise terminated. I agree to pay for the reasonable costs of collection in the event that collection efforts become necessary. I understand that a service fee of $20.00 will be assessed for each non-sufficient fund check and/or certified letter that must be sent. All accounts unpaid after 30 days receive a $5.00 Billing Charge each month and a late charge computed at a periodic rate of 1.50% per month, which is an annual percentage rate of 18.00% with a minimum monthly charge of $1.00. I understand that veterinary service is provided during the nighttime hours as necessary in the judgment of the veterinarian in charge and that continuous presence of qualified personnel may not be provided.

Animal Medical History