Client Information Form

Call or Text: 408-356-2181 [email protected]

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Please provide your contact information.

Today's Date:

Owner Name *

First

Last

Co-Owner Name

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Primary Phone *

Work Phone

Cell Phone

Co-Owner Cell

Email *

* Please note; your privacy is important to us. All information you provide us is considered confidential.

Are you a returning client?

Glad to have you back!

How did you learn about our hospital? *

Facebook
Google
Twitter
Yelp
Other (specify below)
Referral (specify below)

If Other, please specify how you found us! *

If a Referral, please provide a name of who referred you. *

Does your pet have medical insurance?

If yes, please specify company name

Emergency Contact Info:

If In the event of an emergency and you / spouse cannot be reached, who may we contact for your pet?

Contact Name *

First

Last

Phone Number *

How is this person related to you?

Any additional information needed regarding this contact?

From time to time we post pet pictures on our webpage and our Facebook page. May we choose your pet?

Fees are payable at time services are rendered. Person presenting the pet is legally responsible for payment of fees. *

I have read and understand

Signature *

Comment

Address

El Gato Veterinary Hospital
15748 Los Gatos Blvd.
Los Gatos, CA 95032

Numbers

Call or Text: 408-356-2181
Fax: 408-356-5790

For 24 hour emergency services, please visit MedVet Campbel (408) 371-6252.

Temporary Hours of Operation

M-F: 9:00 am - 5:00 pm
Saturday: Closed
Sunday: Closed

Even though we’re located in Los Gatos, CA, we’re happy to provide veterinary care to pets in Campbell, San Jose, Santa Clara, Sunnyvale, Mountain View, Morgan Hill, Boulder Creek, Felton, Cupertino, Monte Sereno, Saratoga, and Scotts Valley! Looking for the best veterinary care in Northern California? Come see the team at El Gato Veterinary Hospital.

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