Open Everyday & Same Day Appointments
Mon-Fri: 7AM to 8PM
Sat-Sun: 8AM to 8PM, Holidays: 8AM to 2PM
 

New Client/Patient Form

Thank you for visiting our hospital. We look forward to getting to know you and your pet. Please help us to provide the best care possible for your pet by taking a moment to fill out this form.

Client / Owner Information
Spouse / Co-Owner Information
How did you hear about us?
Please tell us about your pet(s)
Please tell us about your pet(s)

I hereby authorize the veterinarian to examine, prescribe for or treat the above-described pet(s). I assume responsibility for all charges incurred in the care of this animal. I also understand that these charges must be paid in full, at the time of release of the pet.

On occasion, Lombard Veterinary Hospital takes photos of our client’s pets for various uses including: educational purposes on social
networking sites, slideshows, and in advertising materials. Your name will never be used; however we may like to use your pet’s name.

**COPY OF DRIVER’S LICENSE OR STATE ID IS REQUIRED FOR SETTING UP YOUR ACCOUNT**