New Client Form

Name: Wildflower Veterinary Hospital
Address: 19 N 42nd Ave #300, Brighton, CO, 80601, United States
Telephone: 720-712-8182
Price range: $

Fill out the form below! We can’t wait to meet you.

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New Client Form

Fill out the following form with your information. Please note: no appointment will be scheduled at this time. Once we receive your form, we will reach out to schedule an appointment.

If you need immediate assistance, please call us at 720-712-8182.

Name *

First

Last

Pronouns

Email *

Primary Phone *

Secondary Phone

Secondary Phone Owner - Is this your phone number or someone else?

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Drivers License Number

Drivers License State

How did you find out about our hospital? If you were referred by someone, who should we thank? *

Authorized decision makers

Previous Veterinarian Name *

May we contact your previous veterinarian for records? *

**Please understand that if we do not have these records we may not be able to provide best care to your pets**

Previous Veterinarian Phone *

Pet Information

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Do you have insurance for your pet? *

Who is your policy with? *

Sex *

Male
Neutered Male
Female
Spayed Female

Known Problems

Do you have another pet to add? *

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Do you have insurance for your pet? *

Who is your policy with? *

Sex *

Male
Neutered Male
Female
Spayed Female

Known Problems *

Do you have another pet to add? *

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Do you have insurance for your pet? *

Who is your policy with? *

Sex *

Male
Neutered Male
Female
Spayed Female

Known Problems *

Do you have another pet to add? *

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Do you have insurance for your pet? *

Who is your policy with? *

Sex *

Male
Neutered Male
Female
Spayed Female

Known Problems *

Do you have another pet to add? *

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Do you have insurance for your pet? *

Who is your policy with? *

Sex *

Male
Neutered Male
Female
Spayed Female

Known Problems *

Social Media Policy

Patients may be featured with a picture, first name and age on social media (facebook, instagram, website, the next hot new thing). If you do not want us to share your super cute puppy, handsome cat, or distinguished senior pet, please let us know. *

Yes, share my pets photo.
No, do not share my pet's photo.

Prescription Policy

We can fill medications here at Wildflower Veterinary Hospital or provide a written prescription for clients with a current VCPR. We do not fax or call any pharmacy. *

Please type Yes, I understand.

View the full policy.

Emergency Care

We are a daytime general practice facility and refer to other clinics for after hours care. *

I understand.

We are a small privately owned local business. Payment in cash or credit card is due at the time of service. *

I understand.

If your pet is brought in by a pet sitter, good samaritan, someone not on the authorized list, etc and your pet is critical do we have your permission to provide emergency care up to a cost specified below if our veterinarian deems it necessary? *

Up to what cost do you authorize?

We try to accommodate as many patients as possible. When appointments are missed it means another patient may have delayed care or be sent to the emergency veterinarian. If you miss an appointment without 24 hours advance notice, all future appointments will be charged a non refundable scheduling fee that will be applied to your visit. *

I understand

How many hours notice is expected to cancel appointments? *

"We strive to create a space of mutual respect and integrity to provide optimal care for pets and their families.” If a client treats any member of the staff with disrespect in person or online (cursing, yelling, physical aggression, intimidation, threats, etc) we will consider this a termination of the VCPR and will send your records to a veterinary office of your choosing. *

I understand.

To serve all of our clients with equal respect-- if you are late beyond 10 minutes your appointment will need to be rescheduled and all future appointments will be subject to a rescheduling fee. This fee will be applied against the costs of the visit and is forfeited for "no-show" appointments. *

I understand.

Message

Are you a new or existing client?

New Clients

Existing Clients

Due to quickly changing schedules, please call or text us to make an appointment.

Get In Touch!

Get in touch! Complete our form, and a member of our team will be in touch with you shortly. If you’re in need of immediate assistance, please contact us at (720) 712-8182.

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Call Us

(720) 712-8182

Text Us

(720) 669-6869

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Email Us

info@wildflowervetco.com

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Visit Us

19 N 42nd Ave #300, Brighton, CO 80601

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When to Find Us

Monday – Friday 8:00 am – 5:00 pm

Doctors’ hours are by appointment only. At this time, we do not accept walk-ins.