New Client Form

APPOINTMENT

We look forward to meeting you! Please complete your new client form below prior to your first appointment with us. If you have any questions, please contact us directly at 360-829-1515.

Owner's Name*
First Last
Email*
Primary Phone*
Secondary Phone
Address*
Street Address Address Line 2 City State ZIP Code
Who else is authorized to make decisions about your pet's healthcare?*
First Last
Phone
Pet's Name*
Species*
- Cat
- Dog
Pet Breed*
Pet Birthday/Age*
Sex*
- Male
- Male (Neutered)
- Female
- Female (Spayed)
Name and Location of Previous Veterinary Hospital
How did you hear of our hospital?
Please list your personal referral's name so we can thank them!
I hereby authorize BVH to perform medical and initial diagnostic/surgical procedures on this animal as required for diagnosis and treatment. I understand that I can terminate treatment at any time by contacting the doctors and assistants. BVH and its staff are leaders and teachers in the veterinary medicine field, thus case information and/or photos may be used in teaching, forms continuing education, web site, social media, and the like. Client information will never be released. In the event that I sell this animal to another owner, I authorize release of medical information to the new owner. **
I have read and understand.
Payment is due as services are rendered. For hospitalized cases, a deposit is required in advance. The balance is due upon discharge from the hospital. You may pay by cash, personal check (with proper identification), and accepted credit cards. If payment arrangements are needed, I understand that they must be agreed upon prior to admitting my pet. In order to avoid misunderstandings, please let us know immediately if these terms are not satisfactory. **
I have read and understand.
Owners Digital Signature*
Date*
MM slash DD slash YYYY
Email
This field is for validation purposes and should be left unchanged.

Compassionate veterinary care for the pets of South King and Pierce Counties since 1978.

Buckley Veterinary Hospital is a small animal veterinary practice conveniently located in Pierce County. Our number one priority is the health and well-being of your pets.

Contact Info

Phone: 360-829-1515
Fax: 360-829-2842
Email: info@buckleyvet.com

Hours

Mon - Fri: 7:00am – 6:00pm
Sat - Sun: Closed

Location

28801 Washington 410
Buckley, WA 98321

Get in touch!

Our team is here to help. Fill out the form below and we’ll be in touch with you shortly.

Name*
First Last
Email*
Phone
How can we help you?*
Comments
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