Option 1

Complete Online

Complete and submit the online form below.

Option 2

Print & Complete

Bring the completed form with you to our hospital.

Download Form

Option 3

Complete on Arrival

If you prefer, fill out the form when you get to our hospital.

New Patient Form

First Name

Last Name

Address

City

State

Zip Code

Primary Contact Phone

Other Contact Phone

Driver's License or ID

Birthdate *required in the event of dispensing controlled substances

How did you hear about us?

If referral, please let us know so we may thank them!

Pet Information #1

Name

Breed

Male/Female

Neutered?

Age or Date of Birth

Color

Microchip?

Previous Hospital (if any)

Pet Information #2

Name

Breed

Male/ Female

Neutered?

Age or Date of Birth?

Color

Microchip?

Previous Hospital (if any)

Social Media Consent

We LOVE to showcase our furry friends on social media! Please let us know if we may post your fur baby’s picture!

Do you give Laguna Hills and its agents permission to post my pet’s picture on social media?

Yes

Payment Policy

PAYMENT IS DUE AT TIME OF SERVICE. WE DO NOT OFFER ANY BILLING SERVICES.
We accept Cash, Check* (with proper ID) Visa, MC, Discover, American Express, Discover, and Care Credit.
*Any check returned from your finangial instituition is subject to a $25 service fee.

Signature (First and Last Name)

Date

Spam Blocker

New Patient Form

Option 1

Complete Online

Option 2

Print & Complete

Option 3

Complete on Arrival

New Patient Form

Pet Information #1

Pet Information #2

Social Media Consent

Payment Policy

Be sure to ask about our Wellness Plans! A great and affordable way to care for your furry friend!

New Patients Welcome