Owner's Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone

Cell Phone

Which number is best to reach you? *

Home
Cell

Can you receive text messages? *

Yes
No

Email *

Add a Co-Owner? *

Yes
No

Name *

First

Last

Home Phone

Cell Phone

Previous Vet:

Previous Vet's Phone Number

Whom should we thank for referring you?

PET HEALTH HISTORY

Pet's Name *

Species *

Canine
Feline

Sex *

Male
Female

Neutered/Spayed? *

Yes
No

Breed *

Color *

Birthdate or Age *

Current Medications

Please bring and give any medical records/vaccine records to the receptionists to make copies.

DIET AND ENVIRONMENT

What food does patient currently eat? *

Amount & Frequency? *

Is your pet on any dietary supplements *

Yes
No

If so, what kind and what dosage? *

Does your pet consume table food? *

Yes
No

Please explain *

Is your pet primarily indoor or outdoor? *

Indoor
Outdoor

Are there any other animals in the household? *

Yes
No

Please describe *

Do you have your pet groomed or boarded outside of your home? *

Yes
No

If so, how often? *

Do you travel outside of California with your pet? *

Yes
No

If so, where? *

PAST HISTORY

Has your pet had any prior illnesses, accidents, or surgeries *

Yes
No

Please explain.

Is your pet aggressive or fearful around strangers? *

Yes
No

Please explain. *

Is your pet on heartworm, flea/tick preventatives? *

Yes
No

How frequently? *

Year-Round
Seasonally

Please list any other medications or supplements your pet receives.

Does your pet have any known allergies to any medications? *

Yes
No

If yes, please list: *

Has your pet ever had a reaction to any vaccines? *

Yes
No

If yes, please list and explain: *

Do you already have an appointment scheduled? *

Yes
No

Appointment Date & Time *

Date

Time

Primary Reason for Appointment / Concern (please be as detailed as possible) *

Patient's Energy Level

Normal
Increased
Decreased

What brand of pet food does your pet eat? (Include frequency and amount):

What brand of flea/tick preventative and when was the last dose given?

For Dogs: What brand of heartworm preventative are you giving and when was the last dose given?

Patient's Appetite

Normal
Increased
Decreased

Drinking / Water Intake

Normal
Increased
Decreased

For Cats Only: does the patient ever urinate or defecate outside of the litter box?

Yes
No

Is the patient coughing?

Yes
No

If yes, for how long?

Is the patient sneezing?

Yes
No

Is the patient vomiting?

Yes
No

If yes, for how long?

OFFICE POLICIES

To allow for ample time for all patients and surgical procedures, Ocean Avenue Veterinary Hospital operates primarily by appointment. We request all our clients be on time for scheduled appointments and procedures. If you are 15 minutes late for your appointment you may be asked to reschedule your appointment. We do take Emergencies; however, these services may be subject to a higher fee schedule. For your convenience, we offer limited same-day appointments for urgent care sick patients they fill up fast, so we recommend calling first thing in the morning.

For your protection, and that of others, pets should be properly restrained by a leash or carrier upon arrival. If your pet requires special accommodations, please give us a call when you arrive so we can assist you and your pet.

If you must cancel an appointment, we ask for 24 hours’ notice. For surgical appointments, we ask for a 48-hour cancellation notice.

We accept cash, debit, or all credit cards. We also offer Care Credit or Scratch Pay financing to help make the highest quality care accessible to all our patients.

We would be more than happy to fill your prescriptions or have your food orders ready for pick-up. Please call ahead or use our website to process refills. Please allow 24-48 hours for prescription refills, special order or controlled substances may require longer. We do not authorize online pharmacy requests by phone or fax if you need a written prescription to be processed at the pharmacy of your choice you will need to pick them up in person.

I hereby authorize the veterinarian to examine, prescribe for, or treat the above described pet. I assume responsibility for all charges incurred in the care of this animal. *

I have read and agree.

I understand that payment is ALWAYS DUE IN FULL at time of service. A deposit of 50% of the treatment plan may be required before treatments or hospitalization of your pet. I recognize that financial concerns should be discussed PRIOR to examination and treatment. *

I have read and agree.

Do we have your permission to share your pet’s image and story on our social media, website, and other forms of related media? *

Yes
No

I authorize my emergency contact (other than myself) to pursue treatment if I am unavailable. Your emergency contact must be an adult over the age of 18. *

I have read and agree

Emergency Contact *

First

Last

Emergency Contact Phone *

Owner's Signature *

Date *

File Upload

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New Client Form

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A member of our team will get back to you within 24-48 hours.

We proudly serve the pets San Francisco and beyond.

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New Client Form

Please fill out this form before your visit. A member of our team will get back to you within 24-48 hours.

Please fill out this form before your visit.
A member of our team will get back to you within 24-48 hours.