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) *

• I am aware that this office DOES NOT BILL and that I am always responsible for payment at the time services are rendered.

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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Submit