New Client Registration 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(s) and look forward to many future years together.

Please complete our New Client Registration form as fully as possible prior to your first appointment. This will help expedite the registration process and give us valuable insight in providing optimal care for your pet(s). The required sections are indicated by an asterisk (*).

Owner
Address
Additional Contact Info
  • Would you like to be contacted via text?
Co-owner
Additional Info
  • How did you find out about our practice?
Pet Info
  • Species *
  • Sex
Terms of Service
  • Please make sure your pets are up to date on their rabies vaccines! These are required by the City for ALL cats and dogs living in Long Beach Animal Control, and any biting pets that are not up to date on their rabies vaccinations will be quarantined by the City at the owner's expense. The law also requires that we report all rabies vaccinations that are given in this hospital to the City. The report includes client name, patient description and contact information.

    I agree to pay for all the services rendered in accordance with the terms and conditions of this office. I, or my agent, hereby authorize the doctor(s) at Belmont Shore Veterinary Hospital to diagnose, prescribe, and treat my animals.

  • I have read and agree to the above Terms of Service. * (required)