We’ll be closed on Tuesday, December 24th, through Thursday, December 26th, for Christmas. We’ll also be closed on Tuesday, December 31st, and Wednesday, January 1st, for New Year’s! For 24-hour emergency veterinary care, please contact BluePearl Pet Hospital in Cedar Rapids at 319-841-5161 or Iowa State University in Ames at 515-294-4900.

We look forward to seeing you!

New Client Form

Please complete the form below before your first visit. If you have any questions, please feel free to contact us.

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New Client Form

Please complete our new client form before your appointment.
You can also download the new client form and bring it with you to your first appointment.

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Owner's Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone

Cell Phone

Which number is best to reach you? *

Home
Cell

Can you receive text messages? *

Email *

Add a co-owner? *

Name *

First

Last

Home Phone

Cell Phone

Previous Vet

Previous Vet's Phone Number

Pet's Name *

Whom should we thank for referring you?

Pet Health History

Pet's Name *

Sex *

Male
Female

Neutered/Spayed? *

Breed *

Color *

Birthdate or Age *

Current Medications *

Please bring and give any medical records/vaccine records to the receptionists to make copies.

Diet And Environment

What food does patient currently eat? *

Amount & frequency? *

Is your pet on any dietary supplements *

If so, what kind and what dosage? *

Does your pet consume table food? *

Please explain. *

Is your pet primarily indoor or outdoor? *

Indoor
Outdoor

Are there any other animals in the household? *

Please describe. *

Do you have your pet groomed or boarded outside of your home? *

If so, how often? *

Past History

Has your pet had any prior illnesses, accidents, or surgeries? *

Please explain. *

Is your pet aggressive or fearful around strangers? *

Please explain. *

Is your pet on heartworm, flea/tick preventatives? *

How frequently? *

Year-Round
Seasonally

Please list any other medications or supplements your pet receives. *

Does your pet have any known allergies to any medications? *

If yes, please list: *

Has your pet ever had a reaction to any vaccines? *

If yes, please list and explain: *

I hereby authorize the veterinarian to examine, prescribe for, or treat the above described pet. I assume responsibility for all charges incurred in the care of this animal. *

I have read and agree

I understand that payment is ALWAYS DUE IN FULL at time of service. A deposit of 50% of the treatment plan may be required before treatments or hospitalization of your pet. I recognize that financial concerns should be discussed PRIOR to examination and treatment. *

I have read and agree

Do we have your permission to share your pet’s image and story on our social media, website, and other forms of related media? *

I authorize my emergency contact (other than myself) to pursue treatment if I am unavailable. Your emergency contact must be an adult over the age of 18. *

I have read and agree

Emergency Contact *

First

Last

Emergency Contact Phone

Owner's Signature *

Clear Signature

Date *

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Your caring veterinarian in Alburnett, IA

Alburnett Veterinary Service is a well-established full-service animal hospital in Alburnett, IA, providing comprehensive medical, surgical, and dental care. We believe veterinary medicine should be constantly improving. Nothing is more important than the health and well-being of your pet.

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Book an Appointment

Book an appointment using our online system! If urgent care is needed (during our business hours) please reach us by phone.

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Walk-In Services

Let us know when you are on your way! Please complete our online walk-in form to allow us time to prepare for your arrival.

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Have a question?

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Address

412 S Main Avenue Alburnett, IA 52202

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contact

P: 319-842-2214
E: alburnettvet@gmail.com

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Hours

Mon: 7:30 AM – 5:00 PM
Tues: 12:00 AM – 5:00 PM
Wed: 7:30 AM – 5:00 PM
Thurs: 7:30 AM – 5:00 PM
Fri: 7:30 AM – 5:00 PM
(Closed for lunch 12:00 PM – 1:00 PM)
Sat: Hours Vary (Please contact the office for availability)
Sun: Closed

Name *

First

Last

Email *

Phone

How can we help you? *

Phone