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New Patient Form

If your pet is a new patient at Green Valley Veterinary Clinic please complete our New Patient Form using any one of the following options.

Request Appointment

Option 1

Complete Online

Fill out and submit the following form online.

Option 2

Print & Complete

Bring the finished form with you to our animal clinic.

Download Form

Option 3

Complete Onsite

Fill out the form when you arrive at our clinic.

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 Green Valley Veterinary Clinic to release patient information to the primary care hospital or veterinarian.
By submitting this form, I hereby authorize Green Valley Veterinary Clinic 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 Green Valley Veterinary Clinic.

New Patients Welcome

Green Valley Veterinary Clinic is accepting new patients! Our experienced vets are passionate about the health of Yucaipa companion animals. Get in touch today to book your pet's first appointment.

(909) 790-2963 Contact