Client Contact Information Update Form Skip to Main Content Skip to Footer

CAREERS | Download Our App

Hours 2752 W Lawrence Ave Suite 3
Chicago, IL 60625

Client Contact Information Update Form

Your Pronouns:

Co-Owners/Spouse's Name:

Co-Owners/Spouse's Pronouns:

Co-Owner Phone Number:

Co-Owner Relationship:

Spouse

Significant Other

Relative

Other

I hereby authorize the staff at Animal House of Chicago to take and share photo images of my pet for use on the clinic social media pages.*

I authorize

I do not authorize

Professional Fees are due at the time services are rendered.

I understand and acknowledge my responsibility as the owner or caretaker of this animal and agree to pay for all charges incurred during the treatment and or care of this animal at the time services are rendered. I understand that outstanding balances have interest charges (up to 2%) and fees, including ALL collection costs.

If appropriate to the species & to prevent the spread of infectious diseases, hospitalized and/or boarding animals must be current on ALL vaccines and free of internal and external parasites. I understand this requirement and authorize the doctor to provide vaccines and parasite control as needed for my pet(s). I am aware that unforeseen events resulting from treatments, procedures, hospitalization, et cetera will not relieve me of my complete financial obligation to all costs incurred regarding the complete care of my pet.

Typed Signature of Agreement:*

Today's Date:*

Animal House of Chicago