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New Client Form

Name: Tarzana Pet Clinic
Address: 18452 Burbank Boulevard, Tarzana, CA, 91356, United States
Telephone: 818-342-3142
Price range: $

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BOOK AN APPOINTMENT

Owner's Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone

Cell Phone

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

Yes
No

Which number is best to reach you? *

Home
Cell

Email *

Add a Co-Owner? *

Yes
No

Previous Veterinarian

Whom should we thank for referring you?

PET HEALTH HISTORY

Do you have an appointment scheduled? *

Yes
No

Pet's Name *

Sex *

Male
Female

Neutered/Spayed? *

Yes
No

Breed *

Color *

Birthdate or Age *

Current Medications

Please bring and give any medical records/vaccine records to the receptionists to make copies.

DIET AND ENVIRONMENT

What food does patient currently eat? *

Amount and Frequency *

Is your pet on any dietary supplements? *

Yes
No

Does your pet consume table food? *

Yes
No

Is your pet primarily indoor or outdoor? *

Indoor
Outdoor

Are there any other animals in the household? *

Yes
No

Do you have your pet groomed or boarded outside of your home? *

Yes
No

Do you travel outside of California with your pet? *

Yes
No

PAST HISTORY

Has your pet had any prior illnesses, accidents, or surgeries? *

Yes
No

Is your pet aggressive or fearful around strangers? *

Yes
No

Is your pet on heartworm or flea/tick preventatives? *

Yes
No

Please list any other medications or supplements your pet receives.

Does your pet have any known allergies to any medications? *

Yes
No

Has your pet ever had a reaction to any vaccines? *

Yes
No

I hereby authorize the veterinarian to examine, prescribe for, or treat the above described pet. I assume responsibility for all charges incurred in the care of this animal. *

I have read and agree.

I understand that payment is ALWAYS DUE IN FULL at time of service. A deposit of 50% of the treatment plan may be required before treatments or hospitalization of your pet. I recognize that financial concerns should be discussed PRIOR to examination and treatment. *

I have read and agree.

Do we have your permission to share your pet’s image and story on our social media, website, and other forms of related media? *

Yes
No

I authorize my emergency contact (other than myself) to pursue treatment if I am unavailable. Your emergency contact must be an adult over the age of 18. *

I have read and agree.

Emergency Contact *

First

Last

Emergency Contact Phone *

Date *

File Upload

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Email

Having trouble completing this form online?

Download the form below and bring it with you to your appointment.

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Trusted veterinary care for the pets of Tarzana, CA and the surrounding communities

Since 1990, the Tarzana Pet Clinic has been a landmark in The Valley for compassionate veterinary care. Located just east of Reseda on Burbank Blvd., the Tarzana Pet Clinic offers the ultimate in quality service for both dogs and cats. We care about your pets!

Location

18452 Burbank Boulevard
Tarzana, CA 91356
Click here for directions.

Contact Info

Text: 818-342-3142

Call: 818-342-3142
Email: tarzanapetclinic@gmail.com

Hours

Mon - Fri: 8:00 am - 5:00 pm
Sat: 8:00 am - 1:00 pm
Sun: Closed

Have a question?

Use the form below to send a message to our team, and we'll be in touch with you shortly. If you're in need of immediate assistance, please contact us directly at 818-342-3142. Please allow 24-48 hours for a response from our team.

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Request your next appointment online from any device! Click the button below to get started.

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