 hello@brilliantvets.com…  212-365-5160

 hello@brilliantvets.com
 212-365-5160

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Existing Client

New Client Form

Thank you for choosing Brilliant Veterinary Care as your preferred New York City veterinarian. Please fill out the following form as thoroughly as possible. If you have any questions, please feel free to call us at 212-365-5160.

new client

New Client Form

Please Note: All * fields are required

Owner Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Primary Phone *

Secondary Phone

How would you prefer to be contacted? *

Email
Phone
Text

Secondary Owner

First

Last

Email

Phone

How did you hear about us?

Pet's Name *

Species *

Dog
Cat

Breed *

Color *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Previous Vet Hospital (if applicable)

Allergies/Conditions

Current Medications (Including Heartworm and Flea prevention)

Would you like to add a 2nd pet? *

Yes
No

Pet's Name *

Species *

Dog
Cat

Breed *

Color *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Allergies/Conditions

Current Medications (Including Heartworm and Flea prevention)

Would you like to add a 3rd pet? *

Yes
No

Pet's Name *

Species *

Dog
Cat

Breed *

Color *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Allergies/Conditions

Current Medications (Including Heartworm and Flea prevention)

Would you like to add a 4th pet? *

Yes
No

Pet's Name *

Species *

Dog
Cat

Breed *

Color *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Allergies/Conditions

Current Medications (Including Heartworm and Flea prevention)

We want your pet to be Facebook Famous! At Brilliant Veterinary Care we sometimes publish our patient’s cute photos or case studies. Do we have your permission to do so? *

Yes. I will allow BVC to use my pet’s image/information on their social media page.
No. I will not allow BVC to use my pet’s image beyond their private medical history.

Reason for Appointment *

All first time clients are required to leave a $125.00 deposit to book an appointment. This fee goes towards the cost of your first visit. After completing and submitting this form please call 212-365-5160 to leave a deposit and book your first appointment. Thank you.

Date *

Email

Make an Appointment!

We look forward to welcoming you at Brilliant Veterinary Care soon.
Request an Appointment today!

Book Now

Contact Us

Brilliant Veterinary Care is located in the Upper West Side of Manhattan.
Please feel free to contact us.

CT Referrals

For referring veterinarians only. Clients interested in booking a CT should direct their veterinarian to our referral form.

Community care catered to our patient’s needs.

We look forward to seeing you soon!

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Have a Question?

Complete the form below and a member of our team will get back to you soon!

Name *

First

Last

Email *

Phone

What made you decide to try our practice today?

How can we help you? *

Phone

BV_logo_blue_110122 (1)

641 Amsterdam Ave
New York, NY 10025

hello@brilliantvets.com

Call us at

Book an Appointment

Mon – Thurs: 8:00am – 6:00pm
Fri: 8:00am – 5:00pm
Sat: Closed
Sun: 8:00am – 5:00pm

Brilliant Veterinary Care is proud to serve the Upper West Side. We take the responsibility of your pet’s care seriously, and when you walk through our doors, we want you to feel at home.

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Online Store

Clients can request prescription refills through our online pharmacy or by emailing pharmacy@brilliantvets.com for any refill inquiries or general pharmacy questions.