Calhan Veterinary Clinic

(719) 347-2702

13425 N. Calhan Highway, Calhan, CO 80808

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Medical Concern Form

Thank you for entrusting your pet’s care to us today! The following information will be used to help our veterinary team accurately complete your pet’s medical history for today’s visit. We will need to be able to contact you or someone with permission to make medical and financial decisions.
Please provide the information below so we may make the most of your scheduled appointment! Thank you!
Owner Name*
Who should we contact to make medical decisions today?*
Name*
Does your pet enjoy visiting the veterinary clinic?*
Are there any concerns for the following: (check all that apply)
Have the symptoms worsened, improved, or stayed the same since you first noticed them?
Is your pet on any medications?*
How much do you feed?*
If measured amount*
How much?
How often?
Have there been any changes in appetite?
Any increase or decrease in water consumption?
Any change in bowel movements?
Does your pet spend time outside, even for walks or in the yard?
Does your pet come into contact with other dogs? Please check all that apply
Has your pet ever had any adverse reaction to any medications, vaccination, or other procedure?*
Was your pet last seen by Calhan Veterinary Clinic?*
Once the doctor has completed your pet’s exam, we will review the recommended treatment plan. I understand that financial responsibilities for services rendered are due at the time of discharge.*
Many of our patients love peanut butter as a snack while visiting our office, but if you or your pet have an allergy to peanut butter, please let us know. Can your pet have peanut butter?*
Drop off appointments: A drop off appointment is available if you are unable to wait at the practice for the duration of your pet’s visit. Please note that there is an additional charge for this service as your pet will be cared for and housed in a kennel until they are able to be picked up. If you need to leave your pet for their appointment, please inform the team member who greets you when you first arrive.*
I certify that I am 18 years of age or older and responsible for the financial and medical decisions for the above-mentioned pet.*
MM slash DD slash YYYY
This field is for validation purposes and should be left unchanged.

Testimonials

Took care of us and my sweet boy Oakley even had a follow up text checking up on my sweet dog the day after. Friendly staff and loved the vet and... read more

Shea W.

This is a great vet. I’m a horse trainer and from time to time I need them to see my clients horses. They always get me a appointment ASAP. They... read more

Mark H.

Wonderful people and the Vet is kind and caring. My dog is deaf so I really want people who will be understanding and handle her gently. Extremely... read more

Sharon S.

Shea W.

Took care of us and my sweet boy Oakley even had a follow up text checking up on my sweet dog the day after. Friendly staff and loved the vet and front desk

Mark H.

This is a great vet. I’m a horse trainer and from time to time I need them to see my clients horses. They always get me a appointment ASAP. They do a great job for my horses and I really appreciate the extra care.

Sharon S.

Wonderful people and the Vet is kind and caring. My dog is deaf so I really want people who will be understanding and handle her gently. Extremely happy with these people!!

Our Location

Calhan Veterinary Clinic

13425 N. Calhan Highway
Calhan, CO 80808

(719) 347-2702

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