Welcome to Oak Park Animal Hospital  

Phone: 708-383-5542                   Email: [email protected]

You and your pet's information will be held confidential.  Please complete and answer all questions.

OWNER INFORMATION

Are you the owner who is responsible for all financial, decisions and needs for you pets?    Yes__  No__

If No, what is the name of your pets owner?    ____________________________________________________

The pet owner who is responsible has to complete this registration (18 years or older).

Owners full name: _______________________________     Co/owners full name:   ___________________________________

Home address:_____________________________________________________________________________

City:  _______________  State: ___________  Zip:_____________

Email:  ___________________________________    Cell Number:  ________________________ 

Employer name: ________________________          Work number:__________________________

PET INFORMATION

Patient 1: Name:________________________________________Breed:________________________________________________

Species: Dog Cat Other _________   Sex: Male Female Unknown       Spay/Neutered?  Yes No Unknown 

Age/Date of birth:  _____________   Color/Markings:  ______________________________

Patient 2: Name:  ____________________________________   Breed:  __________________________________________

Species: Dog Cat Other   _________     Sex: Male Female Unknown       Spay/Neutered? Yes No Unknown

Age/Date of birth:  _____________    Color/Markings:   _________________________________

Please list previous veterinary providers:

Name of Hospital :  ______________________________________   Veterinarian Name:  _____________________________________

Telephone Number:  ____________________________________    Date of last visit:  ___________________________

Did someone refer you to our hospital?  If so, you will receive 50% off the exam fee today.

Referral Name:_____________________________________________________Telephone #:________________________________

Do we have consent to post cute/informational/educational photos of your pets on our social media in a positive manner?

Yes    No Initial:_________

PAYMENTS AND PAYMENT POLICY

**First time clients will be required to pay a $25 deposit before any services can be rendered.  No checks are allowed for first time clients.**

Payment in full are expected when service is rendered. Some procedures and services require full payment in advance or deposit.  We provide many payment options for your convenience.  We do not accept check payments on the first visit.  A $49.00 NSF fee will be applied for any returned checks. 

We accept CARE CREDIT:  Six months no interest credit card based on approval.  You can call 1-800-859-9975 or register online at www.carecrediet.com.

Treatment Plans: We can provide you with a written estimate in advance and you can decide what level of care you want for your pets. (Please ask for a treatment plan BEFORE service is provided.)

Hospital Tour:  If you would like a tour of the hospital please let us know.

Owner Signature:   ___________________________________