Owner's Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone

Cell Phone *

Which number is best to reach you? *

Home
Cell

Can you receive text messages? *

Yes
No

Email *

Do you prefer phone call, text messaging, or email for communication? *

Call
Text
Email

Add a Co-Owner? *

Yes
No

Name *

First

Last

Home Phone

Cell Phone

Previous Vet:

Previous Vet's Phone Number

PET HEALTH HISTORY

Pet's Name *

Sex *

Male
Female

Neutered/Spayed? *

Yes
No

Breed *

Color *

Birthdate or Age *

Is your pet microchipped? *

Yes
No

Is your pet currently up to date on vaccines? *

Yes
No

Does your pet have any know allergies to medications? *

Yes
No

If yes, please explain *

Please list medications and/or supplements your pet is currently taking

Please list any other relevant or past health history that we should know about

Upload a photo of your pet

Click or drag a file to this area to upload.

Reason for visit *

Please give a detailed description of the reason for your pet’s visit. The more information the better!

OFFICE POLICIES

To allow ample time for all patients and surgical procedures, RoxPaw Animal Clinic operates primarily by appointment. If you are 15 minutes late to your appointment, you may be asked to reschedule. Please give us a call first if you are running behind.

We do take day-time emergencies; however, these services may be subject to a higher fee schedule. For your convenience, we offer limited same-day appointments for urgent care sick patients.

For your protection, and that of others, pets should be properly restrained by a leash or carrier upon arrival. If your pet requires special accommodations, please give us a call when you arrive so we can assist you and your pet.

If you must cancel an appointment, we ask for a 24-hour notice. For surgical appointments, we ask for a 48-hour cancellation notice.

We accept cash, debit, or all credit cards. We also offer Care Credit financing to help make the highest quality care accessible to all our patients.

If your pet needs a medication refill or prescription diet, feel free to either call or send us an email. Please allow 24-48 hours for preparation. If the medication is a special order, it may take longer to arrive. If you are ordering from an online pharmacy, we ask that when you place your order, please let them know that we require paper approval (not phone or fax). If you are ordering through the RoxPaw online pharmacy (we thank you for supporting your local vet!), we can handle the approval quickly.

I hereby authorize the veterinarian to examine, prescribe for, or treat the above described pet. I assume responsibility for all charges incurred in the care of this animal. *

I have read and agree.

I understand that payment is ALWAYS DUE IN FULL at time of service. A deposit of 50% of the treatment plan may be required before treatments or hospitalization of your pet. I recognize that financial concerns should be discussed PRIOR to examination and treatment. *

I have read and agree.

I authorize my emergency contact (other than myself) to pursue treatment if I am unavailable. Your emergency contact must be an adult over the age of 18. *

I have read and agree

Emergency Contact *

First

Last

Emergency Contact Phone *

Owner's Signature *

Date *

File Upload

Click or drag files to this area to upload. You can upload up to 5 files.

Drop Off Form

Please complete this form before your visit

Compassionate care for pets and their people.

Expert veterinary care for the dogs and cats of Littleton, Parker, Castle Rock, Englewood, Centennial, Lone Tree, Denver, and Highlands Ranch.

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