Welcome to Portage Park Animal Hospital in Chicago! We appreciate you trusting us to care for your dog or cat.
Please fill out the form below so we can create your account. We’ll send you a text once you have been set up in our system. You can then call us at your convenience to schedule your first appointment. The cost of the first exam is $79. Any diagnostics, vaccines, etc., are additional. We do require a $79 deposit when scheduling this appointment which goes towards the cost of your first visit. After you’re an established client with us, you do not need to leave a deposit when scheduling.
It’s critical that we receive your pet’s previous medical history before their first visit. If you don’t have their records to upload today, please let us know the veterinary clinic you’ve been to in the past. We will call them to get a copy.
Owner Information
Last Name *
First Name *
Street Address *
City *
State *
Zip Code *
Phone *
Is this number *
HomeCellWork
Can we send text reminders to this cell phone? *
YesNo
Email *
Where did you hear about us? *
Co-Owner Information (optional)
Last Name
First Name
Phone
Is this number
HomeCellWork
Can we send text reminders to this cell phone?
YesNo
Patient Information
Pet's Name *
Type of Pet *
DogCatRabbitOther
Gender *
MaleFemale
Spayed / Neutered? *
YesNoUnknown
Age (years or months) / Birthdate (xx/xx/xx) *
Breed *
Color / Markings *
Where has your pet been taken before for shots or illness?*
Please upload any previous medical records you have:
Do you already have an appointment scheduled? *
YesNo
If "Yes", when is it scheduled for?
Please share if your pet has a social media account
If you have additional pets you'd like to add, we can complete that at your first appointment.
Parking at our clinic
Please note, there is a "Loading Zone" in front of our clinic. You are welcome to park here during your visit. This parking area is designated for Portage Park Animal Hospital clients only.
Social Media Policy
I hereby grant Portage Park Animal Hospital permission to take photographs of my pet and/or myself, and to publish those photographs for any lawful purpose, including, but not limited to, their website, social media accounts, and promotional materials, either digital or in print, in perpetuity. I also grant permission to use my pet’s name.
If you’d like to OPT OUT, please check here.
OPT OUT
Financial Policy
Portage Park Animal Hospital requires payment in full for professional services when your pet is discharged from the hospital. For those who prefer payment plans or credit options, please click visit www.carecredit.com.
By checking below you certify that you are the owner of the above pet, have the authorization to consent to treatment if and when it is needed and are assuming financial responsibilities for all services rendered.
Confirmation *
I Agree
