Vaccine Decline Form

Please make sure that all boxes are checked before continuing.
By signing this form, I understand the complications of declining vaccines as provided to me by the staff members at Animal Hospital of Lake Villa and still choose to decline them. I hold both veterinarians and staff harmless should illness, injury or death result from declining the recommended vaccines.

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

Phone: (847) 356-8387
Text: (847) 356-8387
Fax: (847) 356-2817

Premier Veterinary Group
Emergency: (847) 548-5300