New Patients Receive a Complimentary Exam

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New Client Form

NEW CLIENTS: PLEASE FILL OUT INFORMATION BELOW

Please provide the information below as completely as possible. All information is strictly confidential.

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 *

Co-Owner Information (optional)

Last Name
First Name
Phone
Is this number
HomeCellWork
Can we send text reminders to this cell phone?
YesNo
Pet's Name *
Type of Pet *
DogCatRabbitOther
Gender *
MaleFemale
Spayed / Neutered? *
YesNoUnknown
Age (years or months) / Birthdate (xx/xx/xx) *
Breed *
Color / Markings *
Are Vaccinations Current?
YesNoUnknown
Do you already have an appointment scheduled? *
YesNo

If "Yes", when is it scheduled for?

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.

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

Contact Us

(773) 725-0260

5419 West Irving Park Road
Chicago, IL 60641
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Payment

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Office Hours

Monday
8am - 8pm
Tuesday
8am - 8pm
Wednesday
8am - 8pm
Thursday
8am - 8pm
Friday
8am - 8pm
Saturday
8am - 4pm
Sunday
Closed

See our office

Take a sneak peak at our clinic with this virtual tour!

Click here!