Client Registration Form

Welcome to our practice! Thank you for choosing us to care for your pet(s)! We are so excited to meet you! To prepare for your upcoming appointment, we kindly ask that you help speed up the check in process by filling out our new client information form prior to your appointment time. Having this completed prior to your arrival will help both the doctors and staff so that we may focus on you and your pet(s) rather than on paperwork!

Date*

Date

Owner's Name*

First NameLast Name

Spouse/Other

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Home Phone Number

Please enter a valid phone number.

Work Phone Number

Please enter a valid phone number.

Cell Phone Number*

Please enter a valid phone number.

Opt In to Text Message Appointment Reminders*

Employer Name

Employer Address

Spouse/Other Employer Name

Spouse/Other Employer Address

Emergency Contact Name*

First NameLast Name

Emergency Contact Phone*

Please enter a valid phone number.

Email*

example@example.com

Opt In to Email Communications/Reminders*

Name and phone number of previous veterinarian(s) who we may contact for medical records?*

If we have not made arrangements to contact your previous veterinarian, we ask that you please send any medical records you may have in your possession to DGAHStaff@gmail.com prior to your appointment or arrive 20 minutes before your scheduled appointment time to review records.

How did you hear about us?*

I authorize photos and videos taken in the animal hospital of my pet(s) and/or family to be posted to the Downers Grove Animal Hospital website and social media pages?*

We kindly ask that if you cannot make your scheduled appointment that you cancel within 24 hours of your appointed time. If you are canceling same day, you must cancel your appointment at least two hours before your appointed time. Those who do not cancel in a timely manner or do not show for their appointment, will be required to pay a non refundable deposit to reschedule.

Please make note that parking and entrance to our facility is in the rear of the building.

Thank you,
The Doctors and Staff of Downers Grove Animal Hospital
635 Ogden Avenue, Downers Grove, IL 60515
630-968-2812

Signature*