WELCOME

Thank you for reaching to schedule an appointment with us!

We value your time – gathering all required information PRIOR to clinic arrival helps to limit your wait time, decrease your pet’s time in the clinic, get important information about your pet relayed to the doctor, and most importantly, helps our team to run as efficiently and effectively as possible. This translates to the ability to keep prices affordable for you!!

Please review our Payment Options & Payment Policy for additional information.

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We proudly serve the pets of Wheat Ridge, CO and Beyond.

Please fill out all of the following information and be as detailed as possible.

Name *

First

Last

Phone *

Email *

Mailing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Are you a previous Lakeside Animal Hospital Client? *

Do you have a regular/primary/family veterinarian your pet(s) normally see? If yes, please provide clinic name, doctor, email and phone

How soon would you like to schedule your appointment?

Pet's Name *

Pet's Age *

Pet Species *

Dog
Cat
Other

Where do your pets spend the majority of their time? *

Indoors
Outdoors

Activity Level *

Normal
High Level
Sedentary

Where does your pet eliminate *

Backyard
Common Area
Indoors

Pet's Breed *

Spayed or Neutered? *

Is your cat indoor exclusively; indoor/outdoor; enclosed outdoors/on-leash/supervised; outdoor exclusively? *

indoor exclusively
indoor/outdoor
enclosed outdoors/on-leash/supervised
outdoor exclusively

How does your pet normally behave when at the vet/groomer or around strangers? (Check All That Apply)

Elaborate as needed on your pet’s behavior in vet clinics (muzzle required, needs oral sedatives, needs injectable sedatives, etc):

What are the problem(s) will we be seeing your pet for during their visit? *

Has a veterinarian seen your pet for this problem before or recommended surgery for your pet? *

Please describe in as much detail as possible when you first saw clinical signs and how long the problem has been going on. *

Vaccine Status [up to date; due now; overdue; I don’t know]? *

For dogs please include Rabies, Bordatella, DHPP/DAPP & Leptospirosis
For cats please include FVRCP, Feline Leukemia, and Rabies

Diet (Type/amount/frequency/recent change?): *

Has your pet experienced a change in appetite or increased thirst? *

How would you describe your pet’s attitude/energy level & demeanor? *

Has your pet experienced increased, frequent, or abnormal urination? Is your pet straining to urinate and producing little or no urine at all? *

Has your pet experienced any recent or unexplained weight loss or excessive weight gain – especially in the belly area? *

Has your pet experienced any recent vomiting, diarrhea, excessive drooling, or other GI issues? *

Has your pet experienced any coughing, sneezing, hacking, wheezing? *

Is your pet taking any medications or supplements? Please include medications and supplements [Rx/OTC] along with the dose, frequency, and duration. *

Do you have any additional questions or concerns that you would like to discuss with the veterinary team members during your pet’s visit? *

Please upload all previous veterinary records, including vaccines, detailed veterinary notes, labwork, x-ray, and other diagnostic results, etc.

Click or drag files to this area to upload. You can upload up to 10 files.

By signing below,
1. I ACKNOWLEDGE failure to answer all questions may result in appointment | surgery | procedure delay, rescheduling or cancellation.
2. I ACKNOWLEDGE it is my responsibility to provide both my pet’s medical and vaccination records PRIOR TO my pet’s appointment and by not doing so could delay my pet’s care, increase my wait time, and incur additional charges. I will email both vaccine and medical records to info@2ndchancevet.com or attach above.
3. I ACKNOWLEDGE older/geriatric patients, overweight/obese, brachycephalic, or pets with underlying medical conditions may incur additional charges.
4. I ACKNOWLEDGE if vaccine records | proof of RABIES vaccination is not provided; a rabies vaccine will be REQUIRED during your pet’s visit:

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WELCOME

We proudly serve the pets of Wheat Ridge, CO and Beyond.

We’re Excited To Meet You

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