FLOSSMOOR Animal Hospital
19581 Governors Hwy Flossmoor IL 60422
Phone: (708) 798-9030
Hours • Map • Send info to phone
Home • Services • New Client Form
Our resources include
Please complete the following so that we can better care for you and your pet.
DOWNLOAD NEW CLIENT FORM PDF VERSION
[*] Indicates required field.
Owner's Name: [*]
Full Address (Include Street, Street#, Apt# if Applicable, City, State and ZIP):[*]
Spouse's Phone (Work):
We enjoy taking pictures & videos of our patients & their families. By checking this box, you authorize the use of such photos & videos for advertising & web use
How did you hear about us?
Friend or Family Referral
If you selected friend or family, can you kindly provide name, address and phone number?
If you selected other, can you kindly explain?
Male / Female?
Birthday (Month / Day / Year):
Spay / neutered?
Date of Last Vaccines?:
To provide you and your pet with the best possible care and customize your pet’s health needs, we have a few specific medical questions:
Does your pet have any of the following symptoms?:
Fleas or Ticks
Does your pet exhibit any of the following behaviors?:
Please explain if you selected "Other":
Does your pet drink more water than a year ago?
Have you noticed changes in pet’s sleep habits?
Does your pet have trouble with stairs or stiffness?
What food is your pet on?
How much do you feed your pet? (Cups)
Do you give your pets any supplements?
Do you give your pets any vitamins?
Do you brush your pet’s teeth?
Is your pet currently protected from heartworms?
Is your pet currently on a flea and tick preventative?
How often do you bathe your pet or trim nails?
Does your pet have a microchip?
If yes, Microchip Number:
Any other concerns you may have about your pet?
How would you prefer to pay for your services?
Website Accessability Policy
Flossmoor Animal Hospital
Veterinary Website Design by Cheshire Partners