Forms

Below you will find various forms to fill out online and submit to our staff to enter into our system prior to you arriving for your appointment.

Click on each form below to download it and fill it out, or feel free to submit the form(s) online so our staff can enter your information prior to you arriving and accelerate the check-in process for you.

New Client/Patient Form is for you to fill out if you are a new client and would like to accelerate the check-in process upon your arrival to our clinic.
Canine General History Form is for you to fill out in order for us to get a better history about your dog for his/her appointment. If you would like, you can fill this form out below and submit it to our staff so you don’t have to fill it out when you come in to the clinic. If you do not want to fill this out online, you can click here to download the form, fill in the information, and then bring it in to the clinic for your dog’s appointment.
Feline General History Form is for you to fill out in order for us to get a better history about your cat for his/her appointment. If you would like, you can fill this form out below and submit it to our staff so you don’t have to fill it out when you come in to the clinic. If you do not want to fill this out online, you can click here to download the form, fill in the information, and then bring it in to the clinic for your cat’s appointment.

New Client/Patient Information

This form is for new clients to fill out prior to arriving for their pet's appointment to accelerate the check-in process.

Date*
Date Format: MM slash DD slash YYYY
Client Information
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Cell Phone*
Your cell phone number will be used for appointment reminders.
Alternate Phone
Email*

Your e-mail address will be used to send appointment/vaccine reminders and rebates to you!
Pet Information
Pet Name*
First
Species*
Breed*
What sex is your pet?*
Is your pet spayed/neutered?*
What color is your pet?*
When is their birthday/how old are they?*
Thank you!
We will enter your information into our system so you don't have to fill out paperwork when you come into our clinic. Please call us if any questions at 719-564-0330!

Canine General History Form

Date*
Date Format: MM slash DD slash YYYY
Client Name*
First Last
Client Primary Phone*
Pet Name*
First
General Information
Why are you bringing your pet in to see us?*
Have you traveled anywhere out of state with your pet?*
If so, when and where?
Is your pet current on vaccines, flea/tick/heartworm medications?*
If so, what kind of product(s) do you give?
Has your pet had any previous medical problems?*
If so, please describe:
Is your pet ever exposed to bodies of water (lakes, streams, puddles, rivers, etc.) or in contact with areas that have rodents?*
If you answered "yes," we recommend asking about Leptospirosis vaccinations.
Does your pet frequent areas where rattlesnakes are present?*
If you answered "yes," we recommend asking about Rattlesnake vaccinations.
Clinical History
Has your pet's activity level or energy level changed recently?*
Have you noticed your pet drinking more water?*
Have you noticed your pet urinating more often?*
Is your pet having difficulties urinating?*
Is your pet vomiting?*
Is your pet having diarrhea?*
Is your pet having trouble having a bowel movement?*
Does your pet have any trouble breathing?*
Have you noticed your pet coughing recently?*
Have you noticed any changes in your pet's skin?*
Have you noticed any weight loss?*
Weight gain?
What kind of food do you feed your pet?*
Has your pet's appetite level changed?*
Is your pet on any medications currently?*
If you answered yes, what kind of medications is your pet on and how often are they given?
Is your pet limping?*
If there are other concerns about your pet not mentioned above, please list below:
On a scale of 1-10 (1 being the worst, and 10 being the best), how well do you think your pet feels?*
Please enter a number from 1 to 10.

Feline General History Form

Date*
Date Format: MM slash DD slash YYYY
Client Name*
First Last
Client Primary Phone*
Pet Name*
First
General Information
Why are you bringing your pet in to see us?*
Have you traveled anywhere out of state with your pet?*
If so, when and where?
Is your pet current on vaccines, flea/tick/heartworm medications?*
If so, what kind of product(s) do you give?
Has your cat had a vaccine reaction in the past (swelling, hives, vomiting, lethargy, etc.)?*
Has your pet had any previous medical problems?*
If so, please describe:
Does your cat stay indoor or outdoors?*
If you answered "outdoor" or "both", we recommend asking about testing for FeLV/FIV.
Clinical History
Has your pet's activity level or energy level changed recently?*
Have you noticed your pet drinking more water?*
Have you noticed your pet urinating more often?*
Is your pet having difficulties urinating?*
Is your pet vomiting?*
Is your pet having diarrhea?*
Is your pet having trouble having a bowel movement?*
Does your pet have any trouble breathing?*
Have you noticed your pet coughing recently?*
Have you noticed any changes in your pet's skin?*
Have you noticed any weight loss?*
Weight gain?
What kind of food do you feed your pet?*
Has your pet's appetite level changed?*
Is your pet on any medications currently?*
If you answered yes, what kind of medications is your pet on and how often are they given?
Is your pet limping?*
If there are other concerns about your pet not mentioned above, please list below:
On a scale of 1-10 (1 being the worst, and 10 being the best), how well do you think your pet feels?*
Please enter a number from 1 to 10.

Please feel free to call us with any questions you may have about any of these forms–we’d be happy to help! You can reach us at 719-564-0330, Monday through Friday, from 8:00 a.m. to 5:30 p.m., and Saturday from 8:00 a.m. to 12:00 p.m.

Forms

New Client/Patient Information

Client Information

Pet Information

Thank you!

Canine General History Form

General Information

Clinical History

Feline General History Form

General Information

Clinical History

Share