New Client Intake Form

Primary Owner's Name (must be a legal adult) *

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Address *

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Phone Number *

Email *

Driver's License/ State ID Number

Secondary Owner/Emergency Contact Information *

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Previous Veterinary Clinic

Name & Breed of Your Pet(s) *

Time and Date of Your Pet's Existing Appointment *

Filling out this form does not guarantee an appointment. If your pet does not have an existing appointment, please call the clinic to schedule one before completing this form.

I am aware that this office DOES NOT BILL and that I am always responsible for payment at the time services are rendered.
I understand the clinic's 10 minute late policy and the need to reschedule or pay a late fee if I am more than 10 minutes late to my 30 minute appointment
I understand the clinic's COVID and mask policy and will reschedule/cancel my appointment if I am feeling sick/or unwell

I hereby authorize the veterinarians of the Bird & Exotic Clinic of Seattle to examine, prescribe for and treat my pet(s). I assume responsibility for all charges incurred in the care of my pet(s). *

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