New Client Form

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Please complete this form before your visit.

Owner's Name*
First Last
Date of Birth*
MM slash DD slash YYYY
Primary Phone*
Work Phone
Email*
Address*
Street Address Address Line 2 City State ZIP Code
Co-Owner's Name*
First Last
Co-Owner's Phone
Co-Owner's Email
Pet's Name*
Species*
- Cat
- Dog
Pet Breed*
Pet Color*
Pet Birthday/Age*
Sex*
- Male
- Male (Neutered)
- Female
- Female (Spayed)
Add another pet?*
- No
- Yes
Second Pet's Name*
Second Pet's Species*
- Cat
- Dog
Second Pet's Breed*
Second Pet's Color*
Second Pet's Age/Date of Birth*
Second Pet's Sex*
- Male
- Male (Neutered)
- Female
- Female (Spayed)
Owners Digital Signature*
Our practice is committed to providing the best treatment to our patients. Our prices are representative of the usual and customary charges for our area. We do not permit billing agreements. We will gladly prepare a written estimate if you desire, please just ask us! We accept all major credit cards, cash, and check. There will be a service charge for any check returned unpaid. Please be aware that if a balance remains unpaid, we may refer your account to a collection agency and you and your family members may be discharged from this practice. To prevent the spread of infectious diseases, all hospitalized patients must be current on all vaccines and free from internal and external parasites. The signature below authorizes this level of preventative care and the appropriate charges will be assessed in the discharge invoice. Thank you for understanding our payment policy. By signing below, I certify that I am 18 years of age or older and that I have read, fully understand and agree to the terms of this agreement, and I sign it voluntarily with full knowledge of its significance.
Date
MM slash DD slash YYYY
Comments
This field is for validation purposes and should be left unchanged.

Welcome to Austin Bluffs Animal Clinic

We're open six days a week to make sure the pets of Colorado Springs get the care that they need.

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Address

4323 Austin Bluffs Parkway
Colorado Springs, CO 80918
Click here for directions.

Contact Info

Phone: 719-598-7879
Fax: 719-598-7539
Email: austinbluffsanimalclinic@msn.com

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Hours

Mon – Fri: 8:00 AM – 5:00 PM
Saturday: 8:00 AM – 12:00 PM
Sunday: Closed

Clinic Closures: New Year's Day - Memorial Day - 4th of July - Labor Day - Thanksgiving Day - Christmas Day