Skip to Main Content

Los Gatos Animal Hospital | Los Gatos

  • 11981 Jack Benny Dr STE 101 Rancho Cucamonga CA 91739 US
  • (909) 941-0841
Ask About Financing

New Patient Form

Please fill out our New Patient Form using one of the options below if your pet is a new patient at Rancho Regional Veterinary Hospital.

Option 1

Complete Online

Complete and submit the online form below.

Option 2

Download Form

Print our Patient Questionnaire and bring it with you to your appointment.

Patient Questionnaire

Option 3

Complete on Arrival

If you prefer, fill out the form when you get to our hospital.

New Patient Form

Owner Information

Emergency Contact

Patient Information

Primary Veterinarian Information

Please fill this section in if we are not your primary care veterinary hospital. By listing your primary care veterinarian, you are authorizing Rancho Regional Veterinary Hospital to release patient information to the primary care hospital or veterinarian.
By submitting this form, I hereby authorize Rancho Regional Veterinary Hospital to render medical care for my pet(s) as deemed necessary by the veterinarian. I understand that no guarantee can be given to the outcome of treatments and take it as my responsibility to comprehend any risks involved. I agree to pay for the cost of all services to which I consent to by written or verbal estimate. I understand that a deposit is required before diagnostics and treatments can be initiated and that payment in full is required prior to discharge of patient from Rancho Regional Veterinary Hospital.

New Patients Welcome

Rancho Regional Veterinary Hospital is accepting new patients! Our experienced vets are passionate about the health of Rancho Cucamonga companion animals. Get in touch today to book your pet's first appointment.

Contact Us

(909) 941-0841 Contact