EmailMeForm
Appointment Request for Vaccines and Services
Please complete the form below. One form per animal.
Due to COVID-19, adoptions, spay/neuter and all other services are by appointment only to La Plata County, Archuleta, Montezuma and surrounding Colorado counties. Out-of-state services are suspended until further notice.
Date:
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MM
/
DD
/
YYYY
Owner Information:
Name:
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First
Last
Primary Phone:
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###
-
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-
####
Physical Address:
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Street Address
City
State / Province / Region
Postal / Zip Code
Email:
*
Animal Information:
Animal Name:
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Age:
*
*
Year
Months
Weight:
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Breed:
*
Gender:
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Male
Female
Spayed/Neutered:
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Yes
No
Primary Color:
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Please select
Black
Brindle
Brown
Calico
Golden
Gray, Blue or Silver
Merle
Red
Tan
Tricolor
Yellow
White
Secondary Color:
Please select
Black
Brindle
Brown
Calico
Golden
Gray, Blue or Silver
Merle
Red
Tan
Tricolor
Yellow
White
Did you adopt your pet from LPCHS?
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Yes
No
Has your pet ever received vaccinations from LPCHS?
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Yes
No
Unsure
Is your pet microchipped?
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Yes
No
Vaccination Requests:
Please select all vaccinations you would like your pet to receive:
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Canine Booster (DA2PPV): Distemper, Adenovirus Type 2, Para Influenza and Parvovirus - $25.00
Feline Booster (FVRCP): Rhinotracheitis, Calicivirus, Panleukopenia, Chlamydia - $25.00
Bordetella (Kennel cough) - $25.00
Rabies (Pet must have been adopted from LPCHS) - $25.00
Oral dewormer - $20.00
Heartworm Test (Blood draw required) - $45.00
Feline Leukemia Test (Blood draw required) – $35.00
Nail Trim - $25.00 or $35.00 if muzzle is required.
Microchip (registration included) - $45.00
Has you pet ever had a bad reaction to a vaccine?
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Yes
No
Is your pet on any medication at this time?
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Yes
No
If yes, what?
COVID-19 Disclaimer:
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I understand a team member will call me to schedule an appointment. Walk-ins are subject to denial.
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I understand payment is due over the phone when appointment is scheduled.
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I understand my pet will receive their vaccinations outside of the shelter. If a shelter team member is unable to administer the vaccine(s) outside, my pet is only allowed inside of the shelter.
