New Cat or Dog Form – Pikes Peak Veterinary Clinic

Stress-Free Visit

We want to make your pet’s visit as enjoyable and stress-free as possible. As such, it’s important for us to understand what your pet finds upsetting or distressing. This information will help us adjust our care to better serve you and comfort your pet. Please answer these questions to the best of your ability.

Does your pet show any reluctance to get into the car or carrier?

Yes
No

How and where does your pet travel in the car (seatbelt, back, front, loose, carrier)?

During travel to the veterinary clinic, does your pet do any of the following?

Check all that apply

If other, please describe:

Does your pet prefer:

Female Veterinarian
Male Veterinarian
No preference

Check any situations listed below that your pet has shown avoidance to or dislike of in the past. You can add comments at the end.

Additional comments:

How would you describe your pet around other animals and people?

Does your pet have any sensitive areas that s/he does not like to have touched by you or others?

Social Media Consent*

I hereby give Pikes Peak Veterinary Clinic (PPVC) permission to take photographs and videos of me and my pet for the purpose of posting on PPVC's Facebook, YouTube, Twitter, clinic website and other social media outlets. I hereby release and discharge PPVC from any and all claims arising out of the use of the photos. PPVC has my permission to use (check one of the following):

Only my pet’s name(s)
My pet’s name(s) and my first name
My pet’s name(s) and my first and last name
I do not consent to photos or videos for PPVC's social media.

Consent and Privacy Agreement*

Consent
I hereby authorize the veterinarian to examine, prescribe for, or treat the above described pet. I assume full responsibility for all charges incurred in the care of this animal. I also understand that the full amount must be paid before my pet can be released to me, and that a deposit may be required for surgical procedures.

Please know that our attention is placed on you and your pet while you are at Pikes Peak Veterinary Clinic. Occasionally we may miss charges and you are authorizing that we may bill you for any missed charges found within 30 days of your appointment.

Privacy
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.

I agree to the terms.

Name

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

New Cat/Dog Form

Save time and fill out online!

Step 1 of 4

Client and pet information

Pet vaccinations and tests

Pet medical information

Stress-Free Visit

Monday	7:30 a.m. – 5:30 p.m.
Tuesday	7:30 a.m. – 7:00 p.m.
Wednesday	7:30 a.m. – 5:30 p.m.
Thursday	7:30 a.m. – 5:30 p.m.
Friday	7:30 a.m. – 5:30 p.m.
Saturday	8:00 a.m. – 12:00 p.m.
Sunday	CLOSED