Welcome to

Veterinary Medical Center Studio City!

We are glad to have the opportunity to care for your pet. To ensure your pet receives the best care we can offer, please fill out this form completely.

First Name *
Last Name *
Phone Number *
Secondary Phone Number *
Email Address *
Address *
City *
State *
Zip *
Preferred Contact Method *
Driver's License *
Date of Birth *
Social Security Number *
How did you hear about us? *
If 'Person', 'Company' or 'Other' fill out referral source below

I authorize the following individual to make treatment decisions and or add patients to my file.

First Name
Last Name
Phone Number
Email Address

Additional authorized caregiver.

First Name
Last Name
Phone Number
Email Address

Patient Information

Pet Name
Species
Breed
Age/Date of Birth
Color
Sex
Canine Vaccine Info
 DHPP-C Rabies Bordetella Heartworm Test Rattlesnake
Canine Vaccine Info
 FVRCP Rabies FeLV FIV


I hereby authorize Veterinary Medical Center, Studio City its employees and/or representatives to render medical and/or surgical care for my pet(s) as deemed necessary by the veterinarian. I understand that payment for treatment, diagnostic test and/or surgery preformed is required in full upon discharge and I accept full financial responsibility. I understand that continuous care may not be provided during some evening/ weekend/holiday hours. I authorize VMCSC to use photos of my pet(s) in ads/promotional items.

Check to Accept
Date *