Online Forms

South Bay Animal Hospital offers our patient form(s) online so you can complete it in the convenience of your own home or office.

Dog Personality Profile

South Bay Dog Personality Profile

Thank you for your interest in the Puppy Playground at South Bay Animal Hospital & Pet Resort! We look forward to working with you and your dog.

Please complete a dog personality profile for each dog to be enrolled at South Bay. There are no right or wrong answers as each dog is unique. We will use your answers to understand something about your dog before the Temperament Evaluation.

Owner's Name:

Phone #:

Email Address:


Dog Information

Dog's Name:

Age:

Birthday:

Breed:

Sex:

Type of Animal:

Breed:

Sex:

Spayed/Neutered:

Age:


Health and Wellness

Describe your dog’s flea and tick prevention program.

Does your dog have any known allergies? If yes, please explain.

Does your dog have any physical disabilities? If yes, please explain the restrictions on your dog

Please list any medications or supplements given to your dog.

Would you like the staff to administer these medications for an additional fee?

Does your pet have any chronic illnesses such as arthritis? If yes, please explain.

What is the current diet you are feeding your dog? Will we need to do any feedings? There is NO additional charge for feeding meals.

Does your dog have any sensitive areas on his/her body? If yes, please explain.


Routine

What is the overall level of exercise of your dog?

What sort of exercise does your dog get regularly?

How often do you walk with your dog? How long are these walks?

Rate your dog’s energy level at play. Please choose the right number.

Easy Going

Total Spaz


Personality

What do you like most about your dog?

What sort of exercise does your dog get regularly?

What annoys you most about your dog?

What 3 things does your dog love to do most in the world?

On a scale of shy to outgoing, where would you rate your dog? Please choose the right number

Extremely shy

Extremely outgoing

What commands does your dog know? How well does s/he obey them?

Sit

Sit

Stay

Come

Drop/Leave it

Is your dog mouthy or does s/he nibble on you, even playfully?

Has your dog ever climbed or jumped a fence?

Would you say your dog barks a lot? If so, is there a reason or trigger behind it?

Is your dog easily frightened by noises, sudden movements, or other things? If yes, please explain.

Does your dog allow you or others to take food or toys away? If no, please explain.

Has your dog been enrolled in daycare before?

How often does your dog interact with dogs outside your household?

How well does s/he get along with dogs outside your household?

Any problems that you’ve noticed?

How does your dog react to strangers?

How does your dog react to puppies?

How does your dog react to another dog approaching him/her?
On Leash:

Off Leash:

What kind of games does your dog play with people?

Has your dog ever growled at someone?

Has your dog ever bitten a person? If yes, explain the circumstance.

Has your dog ever bitten another dog? If yes, explain the circumstance.

Does your dog have any known aggression and/or fears?

Any other information about your dog you would like to share with us?

Registration Form


South Bay Animal Hospital & Pet Resort
Registration Form

Today’s date:

Client Folder Number:


CLIENT INFORMATION

Client’s Name:

Prefix:

Preferred Phone Number:

Is this your legal name?

If not, what is your legal name?

Home phone no.:

Birth date:

Street address:

Cellular Phone no.:

Work phone no.:

P.O. box:

City:

State:

ZIP Code:

May we use pictures of you and/or your pet(s) on our social media?

E-mail:

Chose clinic because/Referred to clinic by (please check one box):


PATIENT INFORMATION
(Please give your insurance information to the receptionist if available.)

Patient Name:

Birth date:

Breed:

Color:

Is he/she micro-chipped?

Sex:

Neutered/ Spayed:

Current Diet:

Visit Type:

Please indicate insurance:

Subscriber’s name:

Policy no.:

Deductible:

Policy no.:

Vaccines Up To Date:

Last Vet Visit:

Previous Vet:


IN CASE OF EMERGENCY

Name of local friend or relative (not living at same address):

Relationship to client:

Home phone no.:

Cell phone no.:


The above information is true to the best of my knowledge. I understand that I am financially responsible for any balance. I also authorize South Bay Animal Hospital & Pet Resort to release any information required to process my claims. I assume responsibility for all charges incurred in the care of my pet(s). I understand that these charges must be paid at the time of release and that a deposit may be required for any surgical procedures, boarding and/or hospitalization. I also understand that South Bay Animal Hospital & Pet Resort does not accept checks or billing. I also understand that no guarantee of successful treatment is made and release the doctors and agents of South Bay Animal Hospital & Pet Resort of any and all liability, and should a dispute arise, I will be financially responsible for any and all legal expenses incurred by both parties...

Owner/Agent signature:

Date:

Boarding Registration


South Bay Animal Hospital & Pet Resort

Boarding Registration

Dates & Times of Boarding​​​​​​​

Drop off Date:

Drop off Time:

Pick up Date:

Pick up Time:


CLIENT INFORMATION

Client’s Name:

Prefix:

Preferred Phone Number:

Is this your legal name?

If not, what is your legal name?

Home phone no.:

Birth date:

Street address:

Cellular Phone no.:

Work phone no.:

P.O. box:

City:

State:

ZIP Code:

May we use pictures of you and/or your pet(s) on our social media?

E-mail:

Chose clinic because/Referred to clinic by (please check one box):



​​​​​​​Feeding Instructions:

Type of food:

How much do you feed:

How often:

When is the last time your pet ate:



Medications * Please list every medication/supplement that will be administered to your pet.

Medication Name:

Instructions:

Next dose due:


Please list all Belongings (bowls, leashes, bedding, etc.) **South Bay Animal Hospital is not responsible for any lost or damaged items**


In case of injury or illness, I request that the doctor(s) at South Bay Animal Hospital & Pet Resort conduct/not conduct medical care as indicated below.

South Bay Animal Hospital is authorized to provide medical treatment as deemed medically necessary.

I agree to medical treatments up to $


Should my pet require cardiopulmonary resuscitation (CPR), including cardiac compressions, positive pressure respiration, emergency medications or other heroic interventions, I request that the doctor(s) at South Bay Animal Hospital conduct/not conduct such medical care as indicated below. If I request such emergency procedures, I agree to be held responsible for veterinary services provided to my pet while staff members pursue treatment and try to reach me for further directions. Regardless of my pet’s recovery or survival, I agree to pay all fees associated with my pet’s treatment(s) and agreed upon by me.


South Bay Animal Hospital is authorized to provide emergency medical treatment including CPR as deemed necessary.

Number where you can be reached:

Alternative Contact (Name/phone) in case of emergency:

Client Signature:

Date:

NEW CLIENT?

SCHEDULE AN APPOINTMENT WITH US

Online appointments must be made between 8:00 am and 4:30 pm. Please call for appointments 24/7!
Emergency Only walk-in hours are between 8:00 pm and 8:00 am.


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