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:

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

Please Read
I understand, by indicating I agree and submitting this registration, that I am responsible for any charges incurred by my pet while in the care of the doctors at River Forest Animal Hospital and that charges are due and payable at the time of service, unless other arrangements are made in advance. Any balance that is carried over a period of 30 days will accrue a monthly finance charge of 1.5% or 18% per annum. Any balance that I leave unpaid will be forwarded to River Forest Animal Hospital's collection agency, and will incur a 25% collection fee for which I am liable, in addition to monthly finance charges.
I have read this statement and -
I Agree
I Disagree



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