New Client Form

Name: Advanced Pet Care
Address: 448 S Arrowhead Ave., San Bernardino, CA, 92408, United States
Telephone: 909-888-1120
Price range: $

Please complete this form before your visit.

BOOK APPOINTMENT

Thank you for giving us the opportunity to care for your pet. Please help us better meet your needs by taking a few moments to fill out this form before your visit.

Client Information

Owner's Name *

First

Last

Co-Owner (if applicable): *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Phone *

Cell Phone *

I consent to receive SMS text messages from Advanced Pet Care. Msg & data rates may apply. Reply STOP to opt-out. *

Yes
No

In Case of EMERGENCY, Call *

Phone *

Contact information for previous medical records: *

How did you hear about us? *

Do you have an existing appointment?

No
Yes

We will gladly prepare a written estimate if you so desire. Professional fees are due at time services are rendered. *

I have read and understand.

To help prevent the spread of infectious diseases, ALL elective surgery patients, hospitalized patients, and boarded animals must be current on ALL core vaccinations. You must provide adequate printed vaccination history at check-in. DUE TO STATE LAW AND INSURANCE REQUIREMENTS, ALL DOGS & CATS MUST BE CURRENT ON RABIES VACCINATION. Vaccination can be updated at the time of your appointment if it is not current. *

I have read and understand.

By signing below, I am verifying that all the above information is correct. I understand that all charges are due when services are rendered, and I accept full responsibility for the charges incurred during every visit to Advanced Pet Care. Furthermore, I hereby agree to pay all costs of collection or legal fees should such action be necessary due to non-payment. *

I have read and understand.

Signature of Owner or Authorized Agent 18 years or older) *

Clear Signature

Date *

Patient Information

Please fill out for all of your Pets!

Pet 1:

Name OR Animal ID Number: *

Species: *

Dog
Cat
Other

Breed: *

Color: *

Birth Date/Age: *

Behavioral problems: *

Sex: *

Male
Female

Spayed / Neutered: *

Yes
No

Does your pet have any known allergies or vaccine reactions? *

Yes
No

Pet Microchipped: *

Yes
No

Pet 2:

Name OR Animal ID Number:

Species:

Dog
Cat
Other

Breed:

Color:

Birth Date/Age:

Behavioral problems:

Sex:

Male
Female

Spayed / Neutered:

Yes
No

Does your pet have any known allergies or vaccine reactions?

Yes
No

Pet Microchipped:

Yes
No

Email

Get In Touch

Caring for the pets of San Bernadino, CA and beyond.

We are a full-service veterinary medical facility, located in San Bernardino, CA. We look forward to seeing you and your furry friends soon!

Contact Info

Phone: 909-888-1120
Fax: 909-885-3500
Email: [email protected]

Address

448 S Arrowhead Ave.
San Bernardino, CA 92408
Click here for directions.

Hours

Mon - Fri: 9 am - 5 pm
Sat & Sun: Closed

Have a question?

Get in touch with our team! Complete the form below and a member of our team will be in touch with you shortly. If you're in need of immediate assistance, please call us directly at 909-888-9188.