New Client Form

We're always happy to see new clients bring in their pets so we're offering a one-time-only gift coupon as a special gift. Print out the coupon and bring it with you. We look forward to seeing you soon.

On or before your first visit to Fountain Valley Animal Hospital, you will need to complete some brief paperwork.

You may choose to fill out the form below if you would like to complete the paperwork before your appointment. This form will be e-mailed to the clinic, and your file will be ready to go when you come in for your first appointment.

Spouse Name

Spouse Phone Number

Do you already have an appointment with us?*

Yes

If yes, what is the date of the appointment?*

How did you hear about our clinic?

PAYMENT IS DUE AT THE TIME OF SERVICE.
For your convenience we accept payment in the form of cash, Visa, MasterCard, Discover, Am Ex, and Care Credit. No personal checks will be accepted. Payment plans are not offered. We reserve the right to refuse/refrain from providing services for any reason. By checking the box below, you give Fountain Valley Animal Hospital permission to have your pet's medical records transferred to our facility.
*

I accept the terms of service

Pet Information

Pet Name*

Species*

Breed*

Color*

Age or Date of Birth*

Gender*

Male - intact

Male - neutered

Female - intact

Female - spayed

Vaccination History*

Existing Conditions*

Current Medications*

Surgical History (including spay and neuter)*

If you would rather complete the paperwork on your first visit, please arrive a few minutes early and have the following information ready:

Contact Name, Address, and Phone Numbers
Emergency Contact Numbers
Email
Age, Breed, and Color
Vaccination History
Existing Conditions
Current Medications
Surgical History including Spay/Neuter