About Us
Services
More

About Us
Services
More

New Client Forms

"*" indicates required fields

Owner Information

First Name*

Last Name*

Owner's Date of Birth*

Any Authorized Guardians:

Are you the legal owner(s) of the Animal(s)*

YesNo

Owners Address*

Primary Phone*

Is the Primary Phone a Cell Phone?*

YesNo

Secondary Phone

Check here to sign up for text reminders

Yes I Want Text Reminders

Owner Email*

Check here to sign up for email reminders

Yes I Would Like Email Reminders

What are we seeing your pet for today?*

How did you become aware of our clinic?*

WebsiteSignFacebookGoogleReferralOther

Pet Information

Pet Name*

Species*

DogCat

Breed*

Color markings*

Pets Date of Birth*

Sex*

MaleFemale

Spay or neutered?*

YesNo

Name of previous vet?*

Would you like us to request medical records from previous caregiver?*

YesNo

Would you like to add a second pet?*

YesNo

PET: 2

Second Pet Name*

Second Pet Species*

DogCat

Breed*

Color markings*

Pets Date of Birth*

Sex*

MaleFemale

Spay or neutered?*

MaleFemale

Name of previous vet?*

Would you like us to request medical records from previous caregiver?*

YesNo

Would you like to add a Third pet?*

YesNo

PET: 3

Third Pet Name*

Third Pet Species*

DogCat

Breed*

Color markings*

Pets Date of Birth*

Sex*

MaleFemale

Spay or neutered?*

YesNo

Name of previous vet?*

Would you like us to request medical records from previous caregiver?*

YesNo

Would you like to add a Third pet?*

YesNo

Audio & Video Recording Policy

To promote the safety of employees, clients, guests and visitors, as well as the security of its facilities, our animal hospital reserves the right to conduct audio and video surveillance of any portion of its premises at any time. Video cameras will be positioned in appropriate places within and around company buildings and premises.
Conversations in work areas and telephone conversations over business phones may be monitored or recorded as a part of normal business operations. Clients, visitors and guests understand that there is no expectation of privacy in connection with the use of this equipment or with the transmission, receipt, or storage of information in this equipment.
The only exceptions to this policy include private areas of restrooms, showers and dressing rooms, and there will not be any audio or video recording in those areas.

Consent*

I acknowledge receipt of a copy and consent to this animal hospital’s policy on audio and video surveillance and expectations of privacy. I understand that by signing this acknowledgement, I acknowledge and consent to the policy

Authorization*

I hereby authorize Westchester Veterinary Center and Cat Clinic to render medical care for my pet(s) as deemed necessary by the veterinarian. I assume responsibility for all charges occurred in the care of the pet(s). I also understand that all fees are due at the time of service. It is our policy to provide a written estimate of fees for any case where in-hospital treatment, emergency care, surgery or hospitalization will be provided. A deposit may be required depending upon the amount of the estimate. All fees are due upon release of patient.

First Name*

Last Name*

Signature*

Date*

Form submitted successfully!

You are missing required fields.

Dynamic Error Description

There was an error processing this form.

Contact Info

8911 S. Sepulveda Blvd
Los Angeles, CA 90045
(310) 645-4444

Company

About Us
Blog
Careers
FAQs

Get Care

Book Appointment
Our Services
Pharmacy

Partner Locations

Looking for care closer to home? Visit other nearby locations within the Companion Pet Partners family.

Marina Veterinary Center

Accessibility Statement

Sitemap

New Client Forms

Owner Information

Pet Information

Audio & Video Recording Policy

Contact Info

Company

Get Care

Partner Locations

Login

OR

Save Search

Saved Searches

Modal title

Update Profile