New to Huntington Beach Pet Hospital?
Please complete the form below and a member of our team will get back to you as quickly as possible with any questions. If this is an emergency situation, please call us at
Daytime Phone Number
Evening Phone Number
Address Line 1
Address Line 2
--- Select state ---
District of Columbia
Age or Birthday
Are your pets vaccines current?
May we contact them for records?
Upload any records you have here:
Click or drag a file to this area to upload.
Please list any medications your pet is currently on.
Reasons or conditions that prompted your visit?
Special requests or conditions?
Please list any additional pets here:
How did you hear about us?
Whom may we thank?
I grant permission to Huntington Beach Pet Hospital, its employees and authorized representatives, to take photographs and/or video of me and/or my pet(s), to copyright, use and publish the same in print and/or electronically. Huntington Beach Pet Hospital may also use my pets' story, including relevant medical information. I agree the Huntington Beach Pet Hospital may use such photographs, videos or stories including me and/or my pet, with or without names, and for any lawful purpose, including for example such purposes as social media, publicity, advertising, and other web content.
Yes, I grant permission
No, I do not wish to have my pet photographed
I understand, by indicating I agree and submitting this registration, that I am responsible for any charges incurred by my pet while in the care of the doctors at Huntington Beach Pet Hospital and that charges are due and payable at the time of service unless other arrangements are made in advance. Any balance that is carried over a period of 30 days will accrue a monthly finance charge of 1.5% or 18% per annum. Any balance that I leave unpaid will be forwarded to Huntington Beach Pet Hospital's collection agency and will incur a 25% collection fee for which I am liable, in addition to monthly finance charges.
I have read this statement and agree.
I have read this statement and disagree.