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New Client and Patient
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New Client and
Patient Form
Please fill out the new client and patient form.
Client Information
Last Name:
*
First Name:
*
Spouse:
Address
*
City:
State:
Zip:
Home Phone
E-mail *
Work Phone
Spouse Work Phone
Cell Phone
*
Spouse Cell Phone
Emergency Contact
Phone
Patient Information
Name:
Sex:
Animal Breed
Reason for visit:
Medical History
Heartworm Test – Date
Results
FELV/FIV Test
Results
Flea Control Product
Any known medical history:
Payment is expected at the time of service. We honor cash, check, Visa, Mastercard, and Discover. In order to avoid misunderstandings, we urge all charges be discussed with the doctor before services are performed. I agree. *
I understand the terms of payments and agree to pay when treatment/services are rendered. (Please initial below)
*
Submit Form
To find more information, please contact us.
Burien Veterinary Hospital is an excellent place to grow your career in veterinary medicine. Be part of our wonderful team!
Contact Us Now!
BURIEN VETERINARY HOSPITAL
At Burien Veterinary Hospital, we serve pets and their guardians in Burien, White Center, Tukwila, Des Moines and the surrounding areas.
Phone
(206) 242-1290
VISIT US
Location
14628 Ambaum Blvd SW, Burien, WA 98166
Hours
Monday - Friday : 9am - 6pm
Saturday & Sunday: Closed
LOCAL RESCUES
HOSPITAL AFFILIATIONS
© 2023 Burien Veterinary Hospital | Veterinary Marketing & Websites by
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Home
About
About Us
Meet Our Team
Services
Wellness
Spay & Neuter
Dentistry
Senior Pet Care
Vaccinations
Microchips
In-House Diagnostics
In-House Pharmacy
Blog
Resources
New Client and Patient
Pet Portal
Career Opportunities
Contact