Client/Patient Information Form

Name: Veterinary Center of Parker, Inc.
Address: 12311 Pine Bluffs Way, Unit 115, Parker, CO, 80134, United States
Telephone: 720-851-0820
Price range: $

Welcome to VCPI! We look forward to meeting you and your pets!

BOOK APPOINTMENT

Client/Patient Information Form

In an effort to enhance your experience with our clinic, we offer our Client/Patient Information Form online so you can complete it in the convenience of your own home or office. This will help make your visit with us go smoother and helps us treat patients as efficiently as possible.

Today's Date(Required)

MM slash DD slash YYYY

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone(Required)

Email(Required)

Pet Information

Pet's Name(Required)

Age/Date of Birth(Required)

Species (dog, cat, etc.)(Required)

Breed(Required)

Color(Required)

Sex(Required)

Male

Neutered Male

Female

Spayed Female

Do you have a second pet?(Required)

Yes

Pet's Name(Required)

Age/Date of Birth(Required)

Species (dog, cat, etc.)(Required)

Breed(Required)

Color(Required)

Sex(Required)

Male

Neutered Male

Female

Spayed Female

Do you have a third pet?(Required)

Yes

Pet's Name(Required)

Age/Date of Birth(Required)

Species (dog, cat, etc.)(Required)

Breed(Required)

Color(Required)

Sex(Required)

Male

Neutered Male

Female

Spayed Female

Do you have a fourth pet?(Required)

Yes

Pet's Name(Required)

Age/Date of Birth(Required)

Species (dog, cat, etc.)(Required)

Breed(Required)

Color(Required)

Sex(Required)

Male

Neutered Male

Female

Spayed Female

Do you have a fifth pet?(Required)

Yes

Pet's Name(Required)

Age/Date of Birth(Required)

Species (dog, cat, etc.)(Required)

Breed(Required)

Color(Required)

Sex(Required)

Male

Neutered Male

Female

Spayed Female

AUTHORIZATION

I affirm that I am the owner of the above Pet and/or am responsible for it. I am 18 years of age or older, and hereby authorize Veterinary Center of Parker, Inc. (VCPI) to administer treatments and perform procedures on the Pet after either verbal or written consultation and approval by me. Upon request I am entitled to know in advance the cost of any treatment or procedure anticipated. I understand there is no guarantee of results with any treatments and procedures performed on the Pet. I assume personal financial responsibility and agree to pay for all charges invoiced at the time of service. In the event the invoice is not paid at time of service, I agree to pay a recurring 1.5% per month interest on any amounts unpaid after 30 days from date of invoice. I also agree that I will pay a $40 service charge for each NSF check, and all costs and expenses, including legal fees, for the collection of all unpaid amounts. If I fail to pick up my Pet within five days of notice, either by email or telephone, my Pet will be considered abandoned. In cases of abandonment, VCPI will have authorization to care for the Pet as VCPI determines necessary up to and including placing in foster care or an animal shelter. I understand and agree that abandonment does not release me from my obligation to pay for all charges incurred under VCPI care.(Required)

I have read and accept the policy.

RECORDS RELEASE

I hereby permit VCPI, its representatives, and employees to send my Pet’s records as needed to other clinics and facilities.(Required)

I have read and accept the policy.

MEDIA RELEASE

I hereby allow VCPI, its representatives, and employees the right to take photographs and videos of me and/or my Pet, and to copyright, use, and publish the same in print and/or electronically. I agree that VCPI may use such photographs/videos of me and/or my Pet with or without my Pet’s name for any lawful purpose, including but not limited to, such purposes as publicity, illustration, advertising, social media, and Web content. I understand my Pet’s image may be edited, copied, exhibited, published, or distributed, and waive any right to royalties or other compensation arising or related to the use of my pet's image or recording.(Required)

I have read and accept the policy.

PRESCRIPTION AND SUPPLEMENT RETURN POLICY

Federal regulations prohibit the return of any prescription product that has left our premises. This includes supplements and preventatives.(Required)

I have read and accept the policy.

CANCELLATION, NO SHOW AND LATE FEE POLICY 

If you arrive more than 10 minutes late for your scheduled appointment, our staff will determine if we are able to still work you in and a $15 work-in fee may be assessed.

If your Pet is scheduled for a procedure with a specialist, there is a $300 deposit paid at the time of scheduling the procedure. This deposit will be credited to the cost of the procedure.

If you need to cancel your specialist appointment, we require a 48-hour notice, or your $300 deposit will be forfeited as a cancellation fee.

If an appointment is missed without 24 hours notice, VCPI reserves the right to charge a no-show fee of up to $75 and impose pre-payment for future appointments. If you miss three or more appointments, VCPI reserves the right to discontinue service to your Pet. If you arrive more than 10 minutes late for your scheduled appointment, our staff will determine if we are able to still work you in and a $15 work-in fee may be assessed. If your Pet is scheduled for a procedure with a specialist, there is a $300 deposit paid at the time of scheduling the procedure. This deposit will be credited to the cost of the procedure. If you need to cancel your specialist appointment, we require a 48-hour notice, or your $300 deposit will be forfeited as a cancellation fee.(Required)

I have read and accept the policy.

STAFF AND CLIENT EXPECTATIONS

VCPI wants to inform of what to expect from VCPI in terms of our professional care and concern for you and your Pet. We, also, want to outline what we ask from you as clients.

What you can expect from VCPI:

Helpful, educational, and engaged staff.
Clearly communicated timelines, recommendations, and expectations.
Top-notch care for your Pet.
Treated with respect and care.

What we ask from you as a client:

We are always happy to provide information and education. If there is anything you do not understand please ask us first.
If you do not receive 5-star care, we ask that you contact us immediately so we can correct it and have the chance to improve in the future.
We expect you to treat our staff with respect and civility. We have a no-tolerance policy for bullying and/or harassment.

VCPI wants to inform of what to expect from VCPI in terms of our professional care and concern for you and your Pet. We, also, want to outline what we ask from you as clients. What you can expect from VCPI: Helpful, educational, and engaged staff. Clearly communicated timelines, recommendations, and expectations. Top-notch care for your Pet. Treated with respect and care. What we ask from you as a client: We are always happy to provide information and education. If there is anything you do not understand please ask us first. If you do not receive 5-star care, we ask that you contact us immediately so we can correct it and have the chance to improve in the future We expect you to treat our staff with respect and civility. We have a no-tolerance policy for bullying and/or harassment.(Required)

I have read and accept the policy.

You can schedule/change an appointment from our App, your Pet Portal or call to speak with a Client Care Representative at 720.851.0820.

Thank you for your understanding and cooperation as we strive to best serve the needs of our clients and their Pet.

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Visit Our Client Resource Center

Visit out our client resource center to browse helpful resources such as videos on various pet topics, tips on puppy and kitten care, and brochures on some of the products and services we offer.

LEARN MORE

Connect For Care

Connect for Care (previously called Return for Care) is a unique CVMA member benefit program designed to unify veterinarians, shelters, and pet owners all around the same common goal: ensuring adopted shelter pets receive the lifelong health care they deserve.

LEARN MORE

We're proud to serve Parker, CO and the surrounding communities.

There is no question too big or too small. If you need anything at all for your pet, please use the information below to contact us immediately.

Location

12373 Pine Bluffs Way
Parker, CO 80134

Hours

Mon – Fri: 7:30AM – 5:00PM
Sat: 8AM – 12PM, Sun: Closed

Contact Info

P: 720-851-0820
E: info@vcparker.net

Have a question?

Complete the form below, and we'll be in touch with you shortly. If you need immediate assistance during business hours, please call us directly at 720-851-0820.

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Phone

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Comment

Appointment

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Book your next appointment with the Veterinary Center of Parker, Inc. online!

BOOK APPOINTMENT

Client/Patient Information Form

Client/Patient Information Form

Pet Information

AUTHORIZATION

RECORDS RELEASE

MEDIA RELEASE

PRESCRIPTION AND SUPPLEMENT RETURN POLICY

CANCELLATION, NO SHOW AND LATE FEE POLICY

STAFF AND CLIENT EXPECTATIONS

Visit Our Client Resource Center

Connect For Care

We're proud to serve Parker, CO and the surrounding communities.

Location

Hours

Contact Info

Have a question?

Ready to come see us?

We look forward to meeting you and your pets soon!

CANCELLATION, NO SHOW AND LATE FEE POLICY 