» New Patient Form

Have you already scheduled an appointment with us for your new pet?*

Yes
No

PLEASE READ BEFORE CONTINUING: This form is to be information gathering ONLY. You must still call to schedule an appointment with Los Altos Veterinary Clinic. You can do so by contacting our office at (650) 948-8287.

Owner Information

Owner Name*

First Last

Spouse/Secondary Owner Name

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Primary Phone*

Secondary Phone

Email*

Email Consent

I consent to receive email alerts about my pet and clinic newsletter.

How did you find out about us?

If referred, who may we thank?

Social Media & Website Consent*

Yes, I give LAVC permission to feature my pet(s) on social media and/or their website.
No, I would prefer my pet(s) not be featured on LAVC's social media and/or website.

Occasionally, we feature patients on our social media pages and website. Please indicate whether you are comfortable with your pet being featured or not.

Pet Information

Pet Name*

Species*

Dog
Cat

Is your pet Spayed/Neutered?*

Yes
No
Not Sure

I give consent for my pet to be scanned for a microchip.*

I give consent
I do not give consent

Age or Date of Birth*

Breed*

Color

Do you have records from another veterinarian that need shared with Los Altos Vet Clinic?*

Yes
No

Name and information of clinic for previous records:

Upload your pet's previous veterinary records:

Max. file size: 50 MB.

What are we seeing your pet for (vaccines, check up, spay/neuter, etc.)?*

Do you have another pet to provide information for?*

Yes
No

Second Pet Information

Pet Name

Species

Dog
Cat

Age or Date of Birth

Breed

Color

Do you have records from another veterinarian that need shared with Los Altos Vet Clinic?

Yes
No

Name and information of clinic for previous records:

Upload your pet's previous veterinary records:

Max. file size: 50 MB.

Do you have another pet to provide information for?

Yes
No

Third Pet Information

Pet Name

Species

Dog
Cat

Age or Date of Birth

Breed

Color

Do you have records from another veterinarian that need shared with Los Altos Vet Clinic?

Yes
No

Name and information of clinic for previous records:

Upload your pet's previous veterinary records:

Max. file size: 50 MB.

Consent to Treat

Owner Consent to Treat*

As the owner of this pet, I agree to the provisions in this agreement and give Los Altos Veterinary Clinic my consent to treat my animal.

At Los Altos Veterinary Clinic our mission is to humanely prolong and improve the relationship between pets and their owners by offering excellent veterinary services in a clean, comfortable and compassionate atmosphere. We reserve the right to refuse service to anyone whose
behavior conflicts with our mission.

We promise that we will do everything we can to make your pet well, safe and comfortable at all times. While every effort is made to avoid potential issues, adverse reactions can happen to any pet at any time when treatment, medications and/or vaccines are administered.

By checking the box, you agree to assume financial responsibility for all services provided to your pet at this office and to not hold the veterinarian and/or staff liable for the care we provide your pet. Payment of fees is due at the time of service. This hospital is not staffed overnight or on the weekends.

New Patient Form

New Patient Form

Owner Information

Pet Information

Second Pet Information

Third Pet Information

Consent to Treat

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