New Client Form

Name: Buckley Veterinary Hospital
Address: 28801 State Route 410 E, Buckley, WA, 98321, United States
Telephone: 360-829-1515
Price range: $

APPOINTMENT

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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.

Name *

First

Last

Email *

Primary Phone *

Secondary Phone

Address *

Address Line 1

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 (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Name and Location of Previous Veterinary Hospital

How did you hear about us? *

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.

Owner's Signature *

Please type your name.

Date *

Email

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, Wed, Fri: 7:00am - 6:00pm
Tues, Thurs: 7:00am - 7:00pm
Sat: 8:00am - 4:00pm
Sun: Closed

Location

28801 State Route 410 E
Buckley, WA 98321

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