Intake Form

Our commitment is to treat you and your fur-family with compassion, empathy and respect.

We promise to love, care for and manage your special friend through every stage of their life and have a comprehensive range of services to assist with this.

I am the owner or authorized agent for the owner and have the authority to execute the consent.
I understand that payment is due in full upon discharge of every patient.
I understand that any estimate provided is valid only for 3 months from the date presented.
I understand that a deposit is required for hospitalized patients and at the time of scheduling all surgical procedures.
I understand that all surgical appointments require a minimum 48-hour notice for cancellations. If this is not met it will result in forfeiting your surgical deposit.

Name(Required)

First Last

Phone(Required)

Email(Required)

Home Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

A requirement from the DEA for Controlled Substances:(Required)

Client D.O.B:

Driver License (State & Number)(Required)

Secondary Client Name:

First Last

Secondary Phone Number:

Are you currently visiting Colorado or a resident?(Required)

RESIDENT

VISITING

May we use your pet’s photos on social media?(Required)

YES

May we call your previous Veterinary for records?(Required)

YES

Name and/or Number of previous Veterinarian:

Signature(Required)

Pet Information

Pet Name(Required)

Age/DOB(Required)

Species & Breed(Required)

Sex(Required)

Spayed/Neutered(Required)

Yes

Color(Required)

Name

This field is for validation purposes and should be left unchanged.