Please note: We are not offering grooming or boarding services at this moment.

New Client Form

Los Feliz Small Animal Hospital is always happy to meet new pets and the people who love them. If you’re new to our practice, we welcome you! In an effort to provide your pet with veterinary care in a timely manner, we have made our Client/Patient Registration form available online.

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

We would like to occasionally email patient exam/vaccine reminders, dental specials and after-exam surveys. Your email address is kept private and not shared.

Cell Phone *

Home Phone

Work Phone

Primary Phone *

Home
Work
Cell

Do we have permission to text your cell phone number for appointment confirmation? *

May we text you information and pictures of your pet when they are in the hospital with us? *

May we share your pet's picture and name on our website and Facebook page? *

Co-Owner Name

Co-Owner Cell Phone Number

Co-Owner Work Phone Number

How did you find us?

Friend/Family
Saw Us From The Street
Yelp
Google "Map Search"
Google Ratings/Google Reviews
Google Search Engine
Other Website Search
Animal Shelter Voucher
Local Business
Nextdoor App
Facebook
Instagram
Condo Association Flyer
Other

Whom may we thank?

Please Explain.

Have you already made an appointment? *

If yes, what date is your appointment? *

Pet's Name *

Pet's Species

Canine
Feline
Other

If other, please explain.

Pet's Sex

Male
Male-Neutered
Female
Female-Spayed
Unknown

Pet's Breed

Mixed breed?

Pet's Color

Markings

Approx. Age or Birthdate

Should we use caution when approaching? *

Please explain.

Is your animal aggressive towards other animals? *

Does your pet need a muzzle? *

Please explain.

Is your pet currently on any medications? *

Please list.

Has your pet been microchipped? *

Yes
No
Not Sure

Microchip Number *

Would you like a microchip implanted? *

Additional Comments

Add a second pet?

Pet's Name *

Pet's Species

Canine
Feline
Other

Please explain.

Pet's Sex

Male
Male-Neutered
Female
Female-Spayed
Unknown

Breed *

Mixed breed?

Pet's Color

Markings

Approx. Age or Birthdate

Should we use caution when approaching? *

Please explain. *

Is your animal aggressive towards other animals? *

Please explain. *

Does your pet need a muzzle? *

Please explain. *

Is your pet currently on any medications? *

Please explain. *

Has your pet been microchipped? *

Microchip Number *

Would you like a microchip implanted? *

Is this your pet's first veterinary appointment? *

When was your pet last seen at a vet office? *

What is the name of the Veterinary Hospital where your pet was last examined and/or where can we obtain their medical records? *

What is the main health issue you would like to discuss with the doctor? *

Additional Comments

Thank you for choosing Los Feliz Small Animal Hospital. Our primary mission is to deliver the best and most comprehensive veterinary care available for your pet. An important part of our mission is making the cost of optimal care as easy and manageable for our clients as possible by offering several payment choices. Payment Options you can choose from are: Cash, Check, Visa, MasterCard, Discover, American Express, or CareCredit.

I understand that Los Feliz Small Animal Hospital requires payment in full at time of discharge. Healthcare plans and surgeries estimated over $500.00 will require a 50% deposit to begin pet's treatment. *
I have read and understand.

I understand that my account may be charged 15% interest on all outstanding balances older than 30 days and that if my account goes 90 days past due it will be turned over to a collection agency. All returned checks may be charged a $40 return check fee. *
I have read and understand.

I authorize the staff of Los Feliz Small Animal Hospital to provide treatment for my pets. *
I have read and understand.

Audio & Video Recording Policy
To promote the safety of employees, clients, guests and visitors, as well as the security of its facilities, our animal hospital reserves the right to conduct audio and video surveillance of any portion of its premises at any time. Video cameras will be positioned in appropriate places within and around company buildings and premises.

Conversations in work areas and telephone conversations over business phones may be monitored or recorded as a part of normal business operations. Clients, visitors and guests understand that there is no expectation of privacy in connection with the use of this equipment or with the transmission, receipt, or storage of information in this equipment.

The only exceptions to this policy include private areas of restrooms, showers and dressing rooms, and there will not be any audio or video recording in those areas.

I acknowledge receipt of a copy and consent to this animal hospital’s policy on audio and video surveillance and expectations of privacy. I understand that by signing this acknowledgement, I acknowledge and consent to the policy. *
I have read and understand.

Digital Signature (Name) *
First
Last

Today's Date *

Pet's Name *

Phone

Contact us with any questions!



Address

3166 Los Feliz Blvd,
Los Angeles, CA 90039
Click here for directions.

Our private parking lot is 20 feet north of our front door.

}

Temporary Hours

Mon: 7:30am to 5pm
Tues: 7:30am to 5pm
Wed: 7:30am to 5pm
Thurs: 7:30am to 5pm
Fri: 7:30am to 5pm
Sat: 8am to 3pm
Sun: Closed

Please note:
Doctor’s hours start at 8:00am.



Contact Info

Call: 323-664-3309
Fax: 323-663-4668
Email: info@lfsah.com