Welcome to Elcvets : We provide Extra Love to your pets
Our Location832 E. Fremont Ave, Sunnyvale, CA 94087
Owner's Name: First
Emergency Contact Phone Number:
How did you hear of our hospital?
Recommendation Sign Yelp Google Other Internet Other
If recommended, by whom?
Number of pets?
Number of dogs:
Number of cats:
Other (please specify):
Name Of Pet:
Dog Cat Other
If you selected Other, please specify:
Date / time of appointment:
Male Neutered Female Spayed
Vaccination History (Date and type of last vaccinations):
Please check any symptoms or problems that you have noticed about your pet below.
Behavioral Problems Bleeding Gums Breathing Problems Coughing Diarrhea Eye Bulging or Bloodshot Gagging Lack of Appetite Limping Loss Of Balance Scooting Scratching Seems Depressed Shaking Head Sneezing Thirst Urination Increased Vomiting Weakness No Symptoms
Pet's current medications:
Describe your pet's diet:
I herby authorize the veterinarian to examine, prescribe for and/or treat the pet described above. I assume full responsibility for all changed included and the care of this animal. I also understand that these charges will be paid at the time of release and that a deposit may be required for surgical treatment.
Signature (print your name):
I agree that ELC Veterinary Clinic may use photographs of my pet with or without the pet's name and for any lawful purpose, including, for example, such purposes as publicity, illustration, advertising, and Web content.
Please ask a member of our Healthcare Team for a written estimate of potential costs.