Pet Portal
New Client and Patient
Boarding Form
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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, Discover and Care-Credit. 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)
*
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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, Seattle, WA 98166
Hours
Monday - Friday : 9am - 6pm
Saturday : 9am - 12pm
Sunday : Closed
LOCAL RESCUES
HOSPITAL AFFILIATIONS
© 2021 Burien Veterinary Hospital | Veterinary Marketing & Websites by
VetMarketingPro
.
Home
About
Services
Wellness
Spay & Neuter
Dentistry
Senior Pet Care
Boarding
Vaccinations
Microchips
In-House Diagnostics
Blog
Resources
New Client and Patient
Boarding Form
Pet Portal
Contact