Owner Information

Name *

First

Last

Alternate Contact

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Primary Phone *

Secondary Phone

I consent to receive SMS text messages from Oceanside Animal Hospital. Msg & data rates may apply. Reply STOP to opt-out. *

Yes
No

Email *

Who can we thank for referring you to us? *

Pet Information

Pet's Name *

Species *

Canine
Feline
Avian
Exotic

Breed/Exotic Species *

Gender *

Male
Female

Age/Date of Birth *

Color *

Is your pet spayed or neutered? *

Yes
No

Is your pet easily approached by strangers? *

Yes
No

If not, what should we be aware of? *

Is your pet insured? *

Yes
No

If interested, ask one of our team members for further information!

Release of Medical Records

I authorize Oceanside Animal Hospital to obtain my named pets medical history and records to best treat my pet.

Yes, I authorize the release of my pet's medical records.

Veterinarian/Animal Hospital Name *

City/State

Social Media Release

I authorize the staff at Oceanside Animal Hospital to release portions of my pet's medical history and record, including personal recollections, radiographs, photographs and/or video images on social media platforms, television, radio or print media for public education purposes and agree to its use in this manner. I agree not to file any claim or lawsuit against the above parties with respect to the release of this information including, without limitation, any claims based on negligence of the parties who release this information. *

Yes, I authorize.
No, I do not authorize.

Additional Pet Information

Do you have a second pet? *

Yes
No

Pet's Name

Species

Canine
Feline
Avian
Exotic

Breed/Exotic Species

Color

If not, what should we be aware of? *

Do you have a third pet? *

Yes
No

Pet's Name

Species

Canine
Feline
Avian
Exotic

Breed/Exotic Species

Color

If not, what should we be aware of? *

Financial Policy

Payment is due at the time services are rendered. Acceptable forms of payment include personal check (payable to Oceanside Animal Hospital), MasterCard, Visa, American Express, Discover, Care Credit, or cash. Please be aware that if you are enrolled in pet insurance, payment is due in full at the time of service and submission of claims for reimbursement is the responsibility of the pet owner. For all procedures (including sedation, surgery, and dentistry) and inpatient care, a written or verbal treatment plan will be created for you to review and ask any questions you may have. A 50% deposit is required at the time of admission and the balance is due in full at the time of discharge. *

I have read and understand.

Cancellation Policy

At Oceanside Animal Hospital, our goal is to provide high quality personalized medical care to our patients. Appointment times are reserved to accommodate your pet’s specific needs. No- shows and late cancellations leave us unable to accommodate pets who need timely access to veterinary care. As such, the following is our updated policy regarding missed appointments and late arrivals: Please call our office promptly if you are unable to keep your appointment. If it is necessary to cancel your appointment, we kindly request that you call at least 24-hours in advance of your reserved appointment time. Veterinary appointments are currently in high demand, and your prompt cancellation will allow another patient access to needed veterinary care. If cancellation notice is less than 24 hours, or if you do not arrive for you scheduled appointment (no-show), we will require a deposit in the amount of the office visit to be made at the time of booking a future appointment, or rescheduling that appointment. The deposit will be applied toward your balance on that day. The deposit is non-refundable and forfeited in the event the appointment is missed. *

I have read and understand.

Extra Label Use

In accordance with the Animal Medicinal Drug Use Clarification Act and U.S Food and Drug Administration (FDA) regulations, Oceanside Animal Hospital veterinarians have the authority to use approved drugs in a manner not in accordance with their approved label. This may include use of medications in different species, for different indications, or at different dose, frequency, and/or route of administration than stated on the approved drug label. Please sign below to confirm your understanding of and consent for the use of extra-label drugs as deemed necessary by your veterinarian for the treatment of your pet. *

I have read and understand.

Medication Withdrawal Period

For food-production animals, it is important to understand that any medications given to your pet, whether a single or repeated administration, take time to be eliminated from the body. It is medications for the minimum amount of time as advised by your veterinarian. The amount of time varies depending on species treated, medications used, and duration, and will be discussed with you before treatment begins. Any animal receiving extra-label treatments (as described above) cannot be used for meat, egg, or milk production and such products cannot be consumed or sold to consumers under any circumstance. Sign below to indicate your understanding of and consent to this policy. *

I have read and understand.

Signature *

Clear Signature

Date *

Dual NewClient Form