Palm Desert Veterinarian | Country Club Animal Clinic Of Palm Desert CA

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Welcome to Country Club Animal Clinic!

Please help us get to know you by supplying the following information. By clicking "submit" at the bottom, you will be sending your completed form electronically. We will collect additinal information at the time of your appointment - please call 760-776-7555 to schedule your appointment!

Last Name *

First Name *

Local Address

City/ Zip

Employer/ Position *

Spouse/ Co-Owner

Second Address (If Applicable)

Home Phone

Cell Phone

Work Phone

Other Phone

Email *

Other person to whom we may release information and/or pet

Emergency Contact

Do you want us to call you to schedule an appointment?

Enter the verification code in the box below.

Verification Code: *

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Hours of Operation

Mon	8am to 6pm
Tue	8am to 5pm
Wed	8am to 5pm
Thu	8am to 5pm
Fri	8am to 5pm
Sat	8am to 2 pm
Sun	Closed

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