New Client Registration Form

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New Client Registration Form

Welcome! Thank you for considering Yucaipa Animal Hospital as your pet’s care provider.

We are dedicated to maintaining the health of your pet. We value the importance of a happy family. Your pet is a special member of your family and ours too! We look forward to many future years together. Our team provides exceptional care while showing respect for you and your beloved companion.

Becoming a client is easy. Feel free to call our veterinary hospital at (909) 794-3118 to book an appointment. To make your check-in easier, please come into our office 15 minutes before your first appointment with this form filled out.

If you have any further questions, please call. We look forward to meeting you and your pets soon!

Owner's Name
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Day-Time Phone*
Evening Phone
Mobile Phone
Email*
Enter Email Confirm Email
Co-owner's Name & Contact #
Name
First Last
Phone
How did you find out about our practice?
- Clinic Location
- Personal Referral
- Internet Search / Website
- Yellow Pages
- Clinic Sign
- Newspaper / Print Media
- Other
If Other, please specify:
If Personal Referral, is there someone we can thank for this referral?
Please use this area to give us any other relevant information about yourself or your family
Pet Information
Pet's Name*
Species*
or if other species
Breed (if known)
Color
Date of Birth or Age (if known)
Special Identification (tattoo, microchip, etc.)
Sex
Previous Veterinary Practice (if any)
Previous Veterinarian (if any)
Date of last vaccines (if known)
Date Format: MM slash DD slash YYYY
What vaccines were given at this time
Is your pet on any medication or supplement?
- Yes
- No
If Yes, please list the medication or supplement
What food does your pet eat?
Does your pet have allergies or drug reactions?
- Yes
- No
If Yes, please list the allergies and reactions
Are there any current or past medical conditions of which we should be aware?
- Yes
- No
If Yes, please comment on the condition(s) and indicate if they are current or past conditions
Please use the following box to give us any other relevant information about your pet

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In this section

New Client Registration Form
Take A Tour
Treatment Plan
What To Expect

New Client Form

Thank you for considering our hospital as your pet’s provider of veterinary services.

We are dedicated to maintaining the health of your pet and look forward to many future years together.

Learn More

Pet Health

We are committed to providing you with great pet health information.

This is for educational purposes only to help you understand your pet’s healthcare needs.

Find Out More

Boarding Request Form

Our facilities will allow your pet to be as comfortable as possible while you are away. Please feel free to contact us for a tour of our facilities at any time.

View Form

Pet Health Library Articles

Yucaipa Animal Hospital is pleased to provide a library of professional articles updated by practice experts. Browse our library of topics or quickly find the article you need.

View Library

Prescription/Food Refill Request

Please use the form below to request your prescription refill or food item. This will save you time when picking up your order. Many prescriptions require your pet to be examined.

View Form

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New Client Registration Form