Skip to main content

Emergencies
Online Store
Rx Refill

Home
About Us
Our Services
Patient Center
Contact Us
(909) 822-8026

Home
About Us
Our Services
Patient Center
Contact Us
(909) 822-8026

Emergencies
Online Store
Rx Refill

Heritage Client Registration

Thank you for giving us the opportunity to care for your pets.

So that we may become better acquainted, please complete the following.

CLIENT INFORMATION

Owner(s)(Required)

Home Phone(Required)

Mobile Phone(Required)

Employer(s)(Required)

Email Address(Required)

Address(Required)

Street Address City County State ZIP Code

Pet #1 Information

Name

Breed/Color

Date of Birth/Age

Sex / Spayed or Neutered?

Any previous serious illness or surgeries

Any allergies to vaccinations or medications

Special diets or medicine

Flea prevention

Heartworm test/prevention

Fecal (stool sample)

Rabies vaccine

Kennel Cough vaccine

Distemper/Parvo vaccine

Feline leukemia vaccine

FVRCP vaccine

Do you have another pet?

Yes

No

Pet #2 Information

Name

Breed/Color

Date of Birth/Age

Sex / Spayed or Neutered?

Any previous serious illness or surgeries

Any allergies to vaccinations or medications

Special diets or medicine

Flea prevention

Heartworm test/prevention

Fecal (stool sample)

Rabies vaccine

Kennel Cough vaccine

Distemper/Parvo vaccine

Feline leukemia vaccine

FVRCP vaccine

Do you have another pet?

Yes

No

Pet #3 Information

Name

Breed/Color

Date of Birth/Age

Sex / Spayed or Neutered?

Any previous serious illness or surgeries

Any allergies to vaccinations or medications

Special diets or medicine

Flea prevention

Heartworm test/prevention

Fecal (stool sample)

Rabies vaccine

Kennel Cough vaccine

Distemper/Parvo vaccine

Feline leukemia vaccine

FVRCP vaccine

How did you become aware of our clinic?(Required)

Drove By

Yellow Pages

Website

Previous client

Personal Referral (Whom may we thank?)

Web search

Yelp!

Other

PROFESSIONAL FEES ARE TO BE PAID AT THE TIME SERVICES ARE RENDERED. PLEASE CHECK YOUR PREFERRED METHOD OF PAYMENT BELOW PROFESSIONAL FEES ARE TO BE PAID AT THE TIME SERVICES ARE RENDERED. PLEASE CHECK YOUR PREFERRED METHOD OF PAYMENT BELOW.

We will gladly prepare a written estimate if you desire. Please ask the receptionist or doctor.

Please indicate choice of payment:(Required)

Cash/Check

Visa

MasterCard

Discover

AMEX

I AM RESPONSIBLE AND AGREE TO PAY IN FULL THE TOTAL CHARGES FOR SERVICES RENDERED AT THE TIME OF DISCHARGE AND ANY FEES INCURRED FOR COLLECTION OF SAID CHARGES. I UNDERSTAND THAT THE FEES ARE BASED ON TREATMENT DEEMED NECESSARY AT THE TIME OF EXAM, TREATMENT OR ADMISSION AND THAT THE ESTIMATE FEE MAY BE RAISED OR LOWERED BY THE ADMINISTRATION OF TREATMENT, MEDICATION, SURGERY OR DIAGNOSTIC TEST.

Sign:(Required)

Signature of person presenting this pet for treatment if other than owner

Name

Address

Street Address City State ZIP Code

Relationship to Owner

Telephone

77645

Contact Info

7940 Cherry Ave, Ste 203
Fontana, CA 92336

Phone: (909) 822-8026

Office Hours

Mon-Sat: 8am-7pm
Sun: Closed

*Last Tuesday of Every Month: 9am-7pm

©2025 Heritage Animal Hospital. Designed and Managed by ViziSites. Terms of Use. Website Accessibility.

We’ve Moved!

Starting Monday, December 16th, 2024, find us at our new location: 7940 Cherry Ave, Ste 203 Fontana, CA 92336

Feel free to call us with any questions.

We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. By clicking “Accept All”, you consent to the use of ALL the cookies. However, you may visit "Cookie Settings" to provide a controlled consent.

Cookie Settings Accept All

Manage consent

Privacy Overview

This website uses cookies to improve your experience while you navigate through the website. Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. We also use third-party cookies that help us analyze and understand how you use this website. These cookies will be stored in your browser only with your consent. You also have the option to opt-out of these cookies. But opting out of some of these cookies may affect your browsing experience.

Necessary

Always Enabled

Necessary cookies are absolutely essential for the website to function properly. This category only includes cookies that ensures basic functionalities and security features of the website. These cookies do not store any personal information.

Non-necessary

Any cookies that may not be particularly necessary for the website to function and is used specifically to collect user personal data via analytics, ads, other embedded contents are termed as non-necessary cookies. It is mandatory to procure user consent prior to running these cookies on your website.