River Forest Animal Hospital

7515 W Lake Street
River Forest, IL 60305

(708)366-8370

riverforestvet.com

New Client Form

Please call us to schedule an appointment for your pet.

To expedite the check-in process at the time of your first appointment, please submit the following form. 

Thank you for your cooperation in letting us assist you.

New Client

Name (required)
First Name (required)
Last Name (required)
Email Address (required) :
Address (required)
Street Address (required)
City (required)
,
State / Province (required)
Zip / Postal Code (required)
Daytime Phone (required)
Phone TypePhone Number (required)
Evening Phone (required)
Phone TypePhone Number (required)
Pet's Name (required)

Age: Years, Months

Type of Pet (required) :
Breed: (required)

Color (required)

Sex: (required)

Male
Female


Neutered/Spayed

Neutered
Spayed


Are your pet's vaccines current? (check box for yes)
Do you have your pet's medical records? (check box for yes)
Are there medical records at another veterinary hospital?

Yes
No


Name of former veterinary hospital

May we request a transfer of records?

Yes
No


Reasons or conditions that prompted your visit?

Special requests or conditions?

Please list any additional pets in your household


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