• Existing Client with New Pet

  • Vaccine History: Please indicate the date your pet last received the following recommended vaccines. 

     

  • Cats :
    FVRCP: Pick a Date  Luekemia: Pick a Date   Rabies:   Pick a Date   

  • Dogs :
    DAPP: Pick a Date  Lepto: Pick a Date   Bordetella:   Pick a Date   Rabies:   Pick a Date   

  • Medical History


    Cats: Has your cat had a Leukemia or FIV blood test, if so what was the date?     Pick a Date      

  • Dogs: Has your dog had a heartworm blood test, if so what was the date?    Pick a Date   

  • Has your pet had a fecal test, if so what date?   Pick a Date  

  • How much time does your pet spend outside?      

  • What type of flea and heart worm preventative are you currently using?      

  • Any prior history of illness or surgery?         

  • Is your pet currently on any medications?         

  • Does your pet have any drug allergies?         

  • Any concerns regarding your pet's behavior?      

  • Does your pet receive any treats?      

  • What does your pet eat and how often?      

  • Controlled Substances Authorization

  • Dr. Kenneth Feigner, MDVM

    Dr. John Komlosy, DVM

    Dr. Moriah Fountain, DVM

    Dr. Johana Leon, DVM

    The following agreement relates to your pet's use of a controlled substance prescribed by a licensed veterinarian at South Bay Veterinary Hospital.

    CURES is a database of Schedule II-VI controlled substances prescribed in the state of California.  It was established by the DEA and DOJ in 2006 to reduce prescription drug abuse and diversion without affecting legitimate medical practice or patient care.  California Law (Health and Safety Code 11165.01) requires ws to report all controlled substances dispensed and provide specified dispensing information to the Department of Justice on a weekly basis.

    If the licensed veterinarian recommends a controlled substance for your pet's condition, these regulations must be met.

    1. Owner's date of birth must be provided (Must be 18 years of age)

    2. By law a maximum of thirty days' supply of medication will be prescribed at any on time

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