New Client Registration

Required fields are marked *. Your signed form is emailed to our team the moment you submit, and you can print or save a copy for your records.

Owner / guardian

The person financially responsible for the pet’s care.

First name *

Last name *

Street address *

City *

State *

ZIP *

Cell phone *

Alternate phone

Email *

How did you hear about us?

Second authorized person (optional)

Someone else who may authorize care or pick up your pet.

Name

Relationship

Phone

Pet 2 (optional)

Tell us about your companion so we can set up their record.

Consent & policies

Please review and check to acknowledge.

I authorize Centinela Animal Hospital and its staff to examine, treat, and provide care for my pet(s), and I confirm the information above is accurate. * I understand payment is due at the time services are rendered. * Please request my pet’s prior medical records from the previous veterinarian listed above. It’s OK to send me appointment reminders and care updates by text or email.

Signature

Sign with your finger on a phone, or your mouse on a computer.

Your full name (printed) *

Draw your signature above *

Date

Sending…

Something went wrong sending the form. Please try again, or call us at (310) 673-1910.

Thank you — you’re registered!

A completed copy of your form has been sent to Centinela Animal Hospital. We’ll have it ready when you arrive.

Want a copy for yourself? Print or save one below.