Burke Forest Veterinary Clinic

6214 Rolling Rd
Springfield, VA 22152

(703)569-8181

www.burkeforestvet.com

Rescue Organization Release Form

This form authorizes Burke Forest Veterinary Clinic to release information to rescue organizations on your behalf to help you find your new companion.

Rescue Information Release Form

Your Name (required)

First Name (required)	Last Name (required)

Previous/Current Pet's Name (required)

Phone (required)
Phone Type	Phone Number (required)

E-Mail Address :

Do you consent for Burke Forest Veterinary Clinic to release information on your behalf to the Rescue Organization of your choice?

Name of Rescue Organization (required)

This authorization is good for one year starting the day you submit the form.

Verify the reCAPTCHA:

HOURS

Day	Open	Close
Monday	8:00am	7:00pm
Tuesday	8:00am	7:00pm
Wednesday	8:00am	7:00pm
Thursday	8:00am	7:00pm
Friday	8:00am	7:00pm
Saturday	8:00am	12:00pm
Sunday	Closed	Closed

All patients are seen by appointment. We do offer drop off visits.

Please call to schedule an appointment or a drop off.

Appointment times are offered in the morning and evening.

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