New Client Form for East Bay Pet Hospital

We're here to make your visit as smooth and stress-free as possible! To help us get to know you and your pet better, we've put together a simple form you can fill out before your appointment. Taking a few minutes now means more quality time with your pet when you arrive, and we can focus on what matters most: keeping your best friend happy and healthy.

vet giving a white dog a treat

New Patient Information

New Client Form

Owner Information

Your Name
Your Name
First
Last
Address
Address
City
State/Province
Zip/Postal

Co-Owner Information

Co-Owner's Name
Co-Owner's Name
First Name
Last Name

Pet Information

Type
Sex
Spayed/Neutered
plus1 Add Pet minus1 Remove Pet

Doctor Referral (if applicable)

I hereby authorize the veterinarian to examine, prescribe for or treat the above-described pet(s). I assume responsibility for all charges incurred in the care of this animal. I also understand that these charges must be paid in full, at the time of release of the pet.