Appointments

Pet Name*

Pet Parent (This should be the name listed at your veterinarian’s office)*

First Last

Family members who will be involved in the appointment

Email*

Phone*

Does this number accepts text messages?*

Yes
No

Address where appt will take place*

Street Address Address Line 2 City State ZIP Code

Is this your mailing address?*

Yes
No

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Instructions - cross streets, house color, cars, etc that will help me find your home.*

How may we help you?*

Who is your pet's veterinarian?

Veterinary Clinic Name

What dates and times are you considering for your appointment or have been scheduled with Dr. Stephanie?*

Please tell us about your pet's issue*

Pet's name*

Species*

Dog
Cat

Breed

Pet's Age and/or Date of Birth

Weight*

Pet's weight*

Exact
Estimated

Sex*

Male
Female

Is your pet spayed or neutered?*

Yes
No

Has your pet bitten (and broken skin) on a person in the last 10 days?*

Yes
No

May we help with aftercare for your pet?*

Private Traditional/Flame Based with ashes returned and a clay paw print
Private Aquamation with ashes returned (plastic urn, paw print at additional fee)
Communal cremation, no ashes returned (paw print at additional fee)
Home Burial or handling cremation on my own
Extra clay paw print or add print to communal cremation

Lear More About Private Aquamation+

If your pet is 35-90 pounds, do you have one person who can safely help lift your pet on a stretcher? If your pet is over 90 pounds, do you have two people who can safely help lift your pet on a stretcher? (We may be able to provide an extra person with enough notice)*

Yes
No

If you were referred, please let us know who sent you our way.

Do we have your authorization to post a memorial about your pet? Your pet's first name and an included photo would be the only identifier.*

Yes
No

If you would like, please upload a photo of your pet

Is there anything else about your pet or any concerns you’d like to share with Dr. Stephanie?

I understand that all present MUST PROPERLY wear a mask for the ENTIRE visit and every effort will be made for the appointment to take place outside if possible and appropriate.*

Yes
No

OFFICE HOURS

PO Box 204
Dacono, CO 80514

Appointments

OFFICE HOURS

PO Box 204Dacono, CO 80514

PO Box 204
Dacono, CO 80514