EmailMeForm
Appointment Request for Vaccines and Services
Please complete the form below. One form per animal.
All services are available by appointment for La Plata, Archuleta, and Montezuma county residents. If you are interested in a Rabies Vaccine, please do not fill this form out and fill out the Rabies Vaccination Request Form instead.
Date:
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MM
/
DD
/
YYYY
Owner Information:
Name:
*
First
Last
Primary Phone:
*
###
-
###
-
####
Physical Address:
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Street Address
City
State / Province / Region
Postal / Zip Code
Email:
*
Animal Information:
Animal Name:
*
Age:
*
*
Year
Months
Weight:
*
Breed:
*
Gender:
*
Male
Female
Spayed/Neutered:
*
Yes
No
Primary Color:
*
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?
*
Yes
No
Has your pet ever received vaccinations from LPCHS?
*
Yes
No
Unsure
Is your pet microchipped?
*
Yes
No
Vaccination Requests:
Please select all vaccinations you would like your pet to receive:
*
Canine Booster (DA2PPV): Distemper, Adenovirus Type 2, Para Influenza and Parvovirus - $35.00
Feline Booster (FVRCP): Rhinotracheitis, Calicivirus, Panleukopenia, Chlamydia - $35.00
Bordetella (Kennel Cough) - $35.00
Strongid Dewormer (Hook, Round & Whipworms) - $10.00
injectable Dewormer (Tapeworms Only) - $35.00
Heartworm Test (Blood Draw Required) - $50.00
Feline Leukemia Test (Blood draw required) – $50.00
Nail Trim - $40
Microchip (Registration Included) - $50.00
Has you pet ever had a bad reaction to a vaccine?
*
Yes
No
Is your pet on any medication at this time?
*
Yes
No
If yes, what?
Disclaimer:
*
A team member will call me to schedule an appointment. Walk-ins are subject to denial.
*
Payment is due over the phone when appointment is scheduled.
*
I am required to provide 24 hours notice when canceling and re-scheduling appointments to avoid being charged. Same day and "no show" appointments are not eligible for a refund.
