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New Patient Form

Please fill out our New Patient Form using one of the options below at your earliest convenience if your pet is a first-time patient at Shane Veterinary Medical Center.

Book Exam Online (310) 305-7297

Option 1

Complete Online

Complete and submit the online form below.

Option 2

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 1

Patient Information 2

Patient Information 3

Primary Veterinarian Information

Please fill this section in if your pet currently or has previously received primary care at another veterinary hospital. By listing your current/former primary care veterinarian, you are authorizing Shane Veterinary Medical Center to request and/or release patient information to the primary care hospital or veterinarian.
By submitting this form, I hereby authorize Shane Veterinary Medical Center 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 Shane Veterinary Medical Center.

New Patients Welcome

Shane Veterinary Medical Center is accepting new patients! Our experienced vets are passionate about the health of Marina del Rey companion animals. Get in touch today to book your pet's first appointment.

Contact Us

Book Online (310) 305-7297