Online Forms

At Anza Animal Clinic, we offer patient forms online so you can complete them in the convenience of your own home or office. Fax us your printed and completed forms or you may bring them during your visit.

New Client Registration Form

Prior to your first visit please complete this form so that we can effectively and efficiently provide the service you deserve!

Owner's Name







Address


















Co-owner's Name







Max. file size: 50 MB.

How did you find out about our practice?








Pet Information

Is your pet on any medication or supplement


Does your pet have allergies or drug reactions?


Are there any current or past medical conditions of which we should be aware?


As a condition for treatment by this office payment is due for service rendered at the time of the visit or any emergency visit. Requests for financial arrangements are declined if not made in advance of treatment. A service charge of $6.00 per month, plus a finance charge of 1.75% per month, or 21% per year, will be added to balances at the end of the month, unless other written arrangements have been made. Should it be necessary to refer this account for collection, reasonable costs, expenses and attorneys’ fees shall be assessed. Returned checks will be charge $20.00.

As owner, or duly authorized agent of the owner, the undersigned hereby consent and authorize the staff of Anza Animal Clinic to care for, treat, and/or anesthetize as they deem advisable in the performance of surgical or therapeutic procedures they determine to be indicated on the above patients or any patients of record. The undersigned accepts financial responsibility of all services rendered and agrees to pay all charges for services at the time and prior to release of the animal from the hospital. A written estimate for all expected services will be provided in advance of treatment if requested. The estimate does not cover costs for services or therapeutics that are not expected but determined to be indicated or necessary at time of service.

Any animal not picked up within 10 days following notification of release shall be deemed abandoned by the owner and will be disposed of according to sections 1834.5 and 1834.6 of the California Civil Code. It is understood that abandonment does not release the undersigned from paying all costs of the veterinary service.

Veterinary service is provided during nighttime hours as necessary in the judgment of the veterinarian in charge.

I hereby authorize Anza Animal Clinic to use my pet’s photo and/or information related to its experiences at Anza Animal Clinic on Social Media for News Media, Promotional Materials, Written Articles, and/or Photographs without expecting payments.


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