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We are pleased to welcome you to our practice. Please take a few minutes to fill out this form as completely as you can.

Owner / Caregiver

Pet Information

Referral Information

Please tell us how you learned about our practice. Check any of the following boxes that apply.

If this was a personal recommendation who may we thank?

Social Media

Breckenridge Animal Hospital may choose to use photographs of your pet on our website, Facebook Page or other forms of social media. Would you like to see pictures of your pet on these pages and agree to us using the images?


We will gladly prepare a written estimate of service fees if you desire. All professional fees are due at the time of services rendered. In case of extensive medical or surgical procedures a deposit will be required and the remainder of the balance is due at discharge.

Statement Of Ownership

By checking below you certify that you are the owner and or agent of the above animal and have the authorization to consent to treatment if and when it is needed.

Exclusive Offer

THIS ---->https://breckenridgeanimal.com/new-patient-center/new-pet-intake-form.html

Day Open Closed
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
8am 8am 8am 8am 8am 8am Closed
6pm 8pm 1pm 8pm 6pm 12pm


"The entire office staff and doctor are the greatest. I am very confident with taking my animal to them. Have been going to this office for over 20 yrs. Very pleased."

- Joyce & GenefLouisville

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