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.

We are only accepting new clients from the borough of Manhattan. New client forms received from outer boroughs will not be processed. We apologize for any inconvenience; however, this change will allow us to better accommodate the neighborhood we built our clinic to serve. Thank you.

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

Phone

How did you hear about us?

Pet's Name *

Species *

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? *

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 $150.00 deposit to book an appointment. This fee goes toward the cost of your first visit. After you complete and submit this form you will receive a welcome letter once your pet is set up in our system. When you receive the welcome letter, please call 212-365-5160 to leave a deposit and book your first appointment. Thank you.

Date *

Phone

New Client Form

New Client Form

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