Seacliff Animal Hospital New Client Registration Form

Seacliff Animal Hospital - New Client Registration

Thank you for giving us the opportunity to care for you pet(s). Please fill out the following new client registration form.
Seacliff Animal Hospital
19635 Main St., #101
Huntington Beach, CA 92648
(714) 969-2691
Name(Required)
Address(Required)
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Your date of birth is required in order to prescribe certain medications for your pet. Please provide your birthdate.
Co-Owner's Name
Email(Required)
How did you become aware of our hospital?
Who were you referred by (so we can thank them!)
Do you already have an appointment scheduled?(Required)
Please note that we are unable to accommodate walk-in appointments in most cases.

Pet Information

Species(Required)

Sex(Required)
Is your pet current on vaccines?(Required)
Do you have an additional pet?
Species(Required)

Sex(Required)
Is your pet current on vaccines?(Required)
Are you able to bring a copy of your pet(s) medical and vaccination records?
Please provide the name and phone for your previous veterinary clinic so we may obtain your pet's medical records.
Authorization(Required)
I hereby authorize the veterinarian to examine, prescribe for or treat my pet(s). I assume responsibility for all charges incurred in the care of my pets(s). I also understand that any additional charges will be paid at the time of release. I also understand that Seacliff AH reserves the right to charge up to $88.00 for missed clinic and surgical appointments if not cancelled at least 24 hours in advance. We do not extend credit or bill for our services. If you have financial concerns, we will be glad to discuss our fees before your pet's examination.
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