Pre-Appointment Check-In / Drop off

Centennial Animal Hospital Pre-Appointment Check-In / Drop off Form

Thank you for giving Centennial Animal Hospital the opportunity to care for your
pet(s). During this time, we are asking all clients to fill this out prior to their pet’s appointment.

I am in this vehicle: *

(please list model & color)

Best Phone number for today's appointment: *

(the Veterinarian and technician will use this number to communicate with you through the appointment.)

Patient's Name *

Patient's Species *

Canine
Feline

Owner's Name *

First

Last

Appointment Date/Time *

Date

Time

Primary Reason for Appointment / Concern (please be as detailed as possible) *

Patient's Energy Level

Normal
Increased
Decreased

List Medications your pet is currently taking

Do you need refills of any of these medications

If you need a medication refill, please list which medications

Do you need refills on any prescription pet food?

If you need a prescription pet food refill, please let us know which kind

Patient's Appetite

Normal
Increased
Decreased

Drinking / Water Intake

Normal
Increased
Decreased

Is the patient coughing?

If yes, for how long?

Is the patient sneezing?

Is the patient vomiting?

If yes, for how long?

Name

We treat your pets like the valued family members they are.

Address

6870 Centennial Blvd.
Colorado Springs, CO 80919
Click here for directions.

Hours

Mon – Fri: 8:00 am – 6:00 pm
Sat: 8:00 am – 12:00 pm
Sun: Closed

Contact

Phone: 719-528-1693
Fax: 719-528-1694
Email: centennialpets@gmail.com

Ready to come see us?

Request an appointment online!

APPOINTMENT