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  - Equine Hospitalization and Surgical Release Form
  - Equine New Patient Registration
- Small Animal
  - Small Animal New Client Form
  - Small Animal Office Visit and Patient Drop-Off Release

Equine New Patient Registration

Name(Required)

First Last

Address(Required)

Street Address City State ZIP Code

Email(Required)

Primary Phone Number(Required)

Can you receive texts on this cell phone?(Required)

Yes

Home Phone Number

Preferred Method of Contact(Required)

Preferred Payment Method(Required)

Cash

Check

Credit Card - Visa, Discover, Mastercard

Care Credit - Only certain Payment Plans accepted

Who may we thank for referring you or how did you hear about us?(Required)

Why did you choose CEC?(Required)

Horse Information

Horse's Show Name

i.e. Registered Name

Horse's Barn Name(Required)

Breed(Required)

Date of Birth(Required)

MM slash DD slash YYYY

Sex(Required)

Mare

Gelding

Stallio

Color(Required)

Tattoo

Markings(Required)

Stable Name

(if different than home)

Stable Address

Street Address City State ZIP Code

Is horse insured?(Required)

Yes

Known Allergies(Required)

Significant History

(serious illness, lameness, colic, etc.)

Trainer Name

First Last

Submit Form

Please upload any medical records, medical imaging, pictures, videos or other relevant information here

Accepted file types: jpg, gif, png, pdf, mp4, mov, Max. file size: 32 MB.

Payment Policy: In order to keep costs low for all clients, please note that payment is due at the time of service. We accept cash, check, Care Credit (limited promotions), and Visa, Discover, and MasterCard credit cards. Please be prepared to pay your balance in full before departure. Thanks! ~The CEC Team

Signature(Required)

This field is for validation purposes and should be left unchanged.

Contact Us

Address: 9616 W Titan Rd | Littleton, CO 80125

(303) 791-4747
wellness@coequine.com

Clinic Hours of Operation

Monday – Friday: 8:00am – 5:00pm

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