Evergreen Animal Hospital

32175 Castle Court
Evergreen, CO 80439-9585




               Request An Appointment

Request An Appointment

Your Name (required)
First Name (required)
Last Name (required)
Mailing Address (required)
Street Address (required)
City (required)
State / Province (required)
Zip / Postal Code (required)
Cell/Home Phone (required)
Phone TypePhone Number (required)
Work Phone (required)
Phone TypePhone Number (required)
E-Mail Address (required) :
Emergency Contact informtion
Check if same as above information
First Name
Last Name
Phone TypePhone Number
Emergency Persons Relationship:

Patient Infomation
Pet's Name (required)

Pet Age: Years, Months

Type of Pet (required)



Sex: (required)


Neutered/Spayed (required)

Neutered Male
Spayed Female

Are your pets vaccines current?
Veterinarian Information
Do you have pets medical records with you?
Name of Referring Veterinary Practice & Name of Veterinarian (required)

May we request a transfer of records?


Please list any additional pets here - additional forms available at checkin.

Just one question for helping us get the word out!
How did you hear about us? (required)
(Please choose one )

Referring Doctor
Mountain Book(Echo)
Web Search
Outdoor Sign
Local Paper
Local Charity
Pet Supply Store

Emergency Care Directive | Financial Responsibility.
In case of an emergency
Please allow Evergreen Animal Hospital (EAH) to make decisions for the care of my pet in case of an emergency. If my animal is transported to this facility, I will be responsible for all payments. Evergreen Animal Hospital will keep a copy of this form in our records.
I have read this emergency care financial agreement and -

I agree
I disagree

Emergency Care Request
Evergreen Animal Hospital will try to contact you as soon as possible if your pet is brought in as an emergency. If I cannot be consulted, I wish for Evergreen Animal Hospital to (Please mark only one)
Choice of care

Take care of my pet to the best that EAH can deliver and I will be responsible for all services rendered.
Only stabilize my animal until I can be consulted. This typically would include oxygen, fluids and pain medication if needed. Hospitalization charges will still apply for all hours my pet is in the care of EAH and I will be responsible for all charges.
I don't want my animal cared for if I'm not present. The care giver of my animal will be sent home without service preformed.

Thank you for allowing Evergreen Animal Hospital to provide for your pets health care needs.

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