New Client Form

Thank you for giving us the opportunity to care for your pet! Please help us meet your needs better by taking a moment to complete this form.
For quality and training purposes all phone calls are recorded.
Separate names with a comma (,)
Click or drag files to this area to upload. You can upload up to 4 files.
I authorize the doctor to provide vaccines and parasite control as needed for my pet. I assume responsibility for all charges incurred in the care of this (these) animal(s). I also understand that these charges will be paid at the time of release unless prior arrangements have been made. A deposit may be required for inpatient procedures at the discretion of the Animal Hospital of Lake Villa. I agree to pay all outstanding balances together with any other charges (finance and/or collection) due thereon. I understand that personal checks are not accepted as a form of payment and I will provide payment in the form of Cash, Care Credit, Scratchpay, Visa, Mastercard, American Express, Discover, or debit cards.

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Animal Hospital of Lake Villa
101 S. Milwaukee Ave.
Lake Villa, IL 60046

Phone: (847) 356-8387
Text: (847) 356-8387
Fax: (847) 558-2606

Premier Veterinary Group
Emergency: (847) 548-5300

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