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Denistry Intake Form

If your pet has an upcoming Dentistry appointment with Dr. Larry Klima, please complete the specialty form below. If you'd like to fill out this form at our office, please arrive 20 minutes early to your first appointment. 

Dentistry Intake Form

Please answer the following questions to the best of your knowledge. 

Owner Information

Emergency Contact

Patient Information

Primary Veterinarian Information

Please fill this section in if we are not your primary care veterinary hospital. By listing your primary care veterinarian, you are authorizing Choice Veterinary Specialists to release patient information to the primary care hospital or veterinarian.
By submitting this form, I hereby authorize Choice Veterinary Specialists to render medical care for my pet(s) as deemed necessary by the veterinarian. I understand that no guarantee can be given to the outcome of treatments and take it as my responsibility to comprehend any risks involved. I agree to pay for the cost of all services to which I consent to by written or verbal estimate. I understand that a deposit is required before diagnostics and treatments can be initiated and that payment in full is required prior to discharge of patient from Choice Veterinary Specialists.

New Patients Welcome

Choice Veterinary Specialists is accepting new patients. Our experienced veterinary specialists are passionate about improving the health of Westminster animals with complex healthcare needs. Contact us today.

(303) 424-6423 Contact