Prospective Client Intake Form

Prospective Client Intake Form

Thank you for your interest in our house-call veterinary services! Our business hours are Monday through Thursday, 9am to 5pm, and Friday, 9am to 1pm. We accept a limited number of clients for routine in-home care and also provide end-of-life care for pets who are not enrolled in our practice outside of normal business hours. Please complete the form below and Dr. Robertson will follow up with her availability. Completing this form does not guarantee acceptance into the practice.
Service Area

For general in-home care, our service area includes Manhattan Beach, Hermosa Beach, El Segundo, West Hawthorne, and North Redondo Beach. For end-of-life care, we are able to extend beyond this area to include Hawthorne, Torrance, Redondo Beach, and Palos Verdes Estates.
Does your address fall within our service area?
Pricing

For full-service veterinary care, our new client examinations are $325. After that, regular examinations are $250 and additional pet examinations are $150 per pet. For end-of-life care, euthanasia visits are $500 in our regular service area and $600 for visits outside of our service area. Euthanasia aftercare services are available for an additional fee.
Owner Information
Full Name

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Location

Street Address (Optional)

Street Address Line 2
CityState / ProvincePostal / Zip Code
Pet Information
Pet Details
Quick Questions
What type of care are you seeking?
What timing are you hoping for?
Are you interested in Extended Access care?
How did you hear about us?
If a friend referred you, please add their name.
Is there anything else you’d like us to know?
Thank you for taking the time to complete this form. We review each submission carefully and will reach out via email shortly.
Should be Empty:

Prospective Client Intake Form

Service Area

Pricing

Owner Information

Pet Information

Quick Questions