Point Loma Veterinary Clinic

1964 Sunset Cliffs Blvd
San Diego, CA 92107

(619)222-4482

www.pointlomavetclinic.com

New Client Information Form

If you would like to make an appointment, you can assist us to expedite your check in by submitting this form.  After filling out the form below, one our our staff members will contact you to verify your appointment date and time.
Thank you for your cooperation in letting us assist you.  We look forward to meeting you!

New Client Information

Name (required)
First Name (required)
Last Name (required)
Alternate Owner Name
First Name
Last Name
Address (required)
Street Address (required)
City (required)
,
State / Province (required)
Zip / Postal Code (required)
Phone Number (required)
Phone TypePhone Number (required)
Alternate Phone Number
Phone TypePhone Number
E-Mail Address (required) :
Pet's Name (required)

Age: Birthdate or Approximate Age

Type of Pet (required) :
Colors (required)

Breed (if known):

Sex and neutered/spayed?: (required)
Male
Neutered
Female
Spayed
Are your pets vaccines current?

Yes
No
Not sure


Medical records at another veterinary practice?
(If you already have medical records for your pet from another veterinary hospital, we strongly recommend that you bring it with you to your appointment or email it to us ahead of time at pointlomavetclinic@gmail.com.)

Yes
No


Name of previous veterinary hospital and phone number (999-999-9999):

May we request a transfer of records?

Yes
No


How did you hear about us (Please select all that apply)? (required)
Friend or word of mouth
Google or other online search engine
Groomer
Pet Store
Location
Humane Society
Adoption Group
Other
If you selected 'Other' please specify:

We schedule appointments for the following times:
Monday - Thursday, every Half Hour, between 9:00 AM - 5:00 PM as last appointment. Saturdays, every Half Hour, between 9:00 AM and 1:30 PM. No appointments on Friday or Sunday available.
Preferred Appointment Date & Time (required) :
Alternate Appointment Date & Time (required) :
Alternate Appointment Date & Time (required) :
Please remember this is a request for a preferred appointment time. Someone will contact you to confirm your appointment time.
We will do our best to reasonably accommodate you. On the day of your scheduled appointment, please arrive 15 minutes prior to your appointment time.

We have reserved parking on the north side of our hospital in the alley between Santa Monica Ave. and Saratoga Ave.
Reasons or conditions that prompted your visit: (required)

Special requests or conditions?

Appointment :

Professional fees are due when services are performed. We accept payment in the form of Visa, Mastercard, or cash. We do not accept debit cards for payments of $10 or less and we do not accept personal checks, Discover or American Express credit cards.
I have read and understand the above statement.

Check the reCAPTCHA to ensure you are not a robot: