New Client Form

We’re excited to see you!

Before your first visit, be sure to complete your New Client Form. If you need immediate assistance, please call us at 847-843-2226.

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Client Information

How did you hear about our practice?



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Pet Information

Pet Species*

Pet Gender*


Additional Pet?

Max. file size: 50 MB.

At Animal Care Clinic, we continually strive to provide the highest quality services through a responsive, professional staff with emphasis on individual attention and commitment to excellence in animal health care.

PAYMENT IN FULL IS DUE AND PAYABLE AT THE TIME SERVICES ARE RENDERED. For your convenience, we accept cash, checks, major bankcards (Visa, Mastercard, Discover) and Care Credit as forms of payment.*
The above listed customer agrees, by signing this authorization, to pay interest at the rate of 1.50% per month, which is the annual percentage rate of 18% on any past due account, and to pay the reasonable attorney's fees and court costs of Animal Care Clinic that are incurred in the collection of any past due account.*

This field is for validation purposes and should be left unchanged.