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Call
719-475-1747
for an appointment
PPVC Online Pharmacy
About
About Us
Staff
FAQ
Services
Forms & Resources
Policies & Forms
Pet Health Library
Blog
Contact
Call
719-475-1747
for an appointment
PPVC Online Pharmacy
About
About Us
Staff
FAQ
Services
Forms & Resources
Policies & Forms
Pet Health Library
Blog
Contact
About
About Us
Staff
FAQ
Services
Forms & Resources
Policies & Forms
Pet Health Library
Blog
Contact
PPVC Online Pharmacy
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About Us
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Canine Infectious Disease Risk Assessment Form
Save time and fill out online!
Pikes Peak Veterinary Clinic uses this Risk Assessment to determine which vaccinations your pet should receive. It is not our belief that every animal needs to receive vaccinations for every disease if their lifestyle does not put them at risk for those diseases. Please answer every question to help us provide the best possible protection for your pet. Should you have any questions, please do not hesitate to ask.
Basic information
Owner's Name
*
First
Last
Pet's Name
*
My pet's appointment is scheduled for:
*
Choose date below
Month
Day
Year
Your dog's lifestyle
Does your dog go to dog parks or daycare?
*
Yes
No
Do you board your dog?
*
Yes
No
Does your dog swim in lakes, ponds, or canals?
*
Yes
No
Do you camp/hike with your dog?
*
Yes
No
Does your dog go to a groomer?
*
Yes
No
Does your dog urinate/defecate on paper?
*
Yes
No
Do you travel with your dog?
*
Yes
No
Where do you travel with your dog?
*
Does your dog eat other animals’ poop?
*
Yes
No
Does your dog visit other dogs either at your home or someone else’s?
*
Yes
No
Do you have contact with other animals without your pet?
*
(e.g. volunteering at a rescue)
Yes
No
Does your dog participate in activities where he/she comes in contact with other animals?
*
(e.g. training, showing, breeding)
Yes
No
Does your dog have access to food/water outside where other animals do as well?
*
Yes
No
Does your dog have a history of any serious illness?
*
Yes
No
Please describe the illness(es) and when your dog has had them:
*
Is your dog on any medications/supplements?
*
Yes
No
Please list the medications and/or supplements:
*
Does your dog have a history of any kind of reaction to vaccines?
*
Yes
No
Please describe your dog's history of reaction:
*
Privacy policy
*
We are the sole owners of the information collected on this site. We only have access to and/or collect information that you voluntarily give us via direct contact from you. We will not sell or rent this information to anyone.
We will use your information to respond to you regarding the reason you contacted us. We will not share your information with any third party outside of our organization other than as necessary to fulfill your request, e.g. to fulfill an order.
Unless you ask us not to, we may contact you in the future to tell you about specials, new products or services, or changes to this privacy policy.
If you feel that we are not abiding by this privacy policy, you should contact us immediately.
We will use your information to respond to you, regarding the reason you contacted us. We will not share your information with any third party outside of our organization, other than as necessary to fulfill your request, e.g. to fulfill an order.
Unless you ask us not to, we may contact you in the future to tell you about specials, new products or services, or changes to this privacy policy.
If you feel that we are not abiding by this privacy policy, you should contact us immediately.
I agree to the privacy policy.
Email
This field is for validation purposes and should be left unchanged.
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