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Appointment
Check-In Form

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forms online from any device at any time before your visit.

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Appointment Check-In Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet before your visit.

Download & Print Form

Your Name *

First

Last

Email *

Pet's Name *

I am the owner or the authorized agent for the owner of the animal described above, and I have the authority to execute this consent. My signature below certifies that I am over eighteen years of age. I have confirmed my address and contact information to be up to date. I accept that my financial obligations remain at time of services rendered. I have read and understand this authorization and hereby accept and agree to the terms of the consent for treatment. *

Initial here

I agree to pay in full at the time of my appointment. Past due invoices will incur a monthly 5% finance charge. Account more than 60 days past due will be sent to our collections agency. *

Initial here

I understand that any appointment/consultation with a veterinarian will incur an exam fee. *

Initial here

I understand that I cannot return dispensed medication after payment has been processed and I have left the premises. *

Initial here

I understand that Touhy Animal Hospital will not authorize any prescription refills through email, phone or fax for 3rd party online pharmacies (such as Chewy, PetMeds, etc.). Please request a written script at the time of your visit. I take full responsibility for products purchased on those platforms. *

Initial here

I agree to act in a courteous manner to all Touhy Animal Hospital personnel. *

Initial here

I consent for Touhy Animal Hospital to take pictures of my pet to use on social media platforms. *

Best phone number to reach you at today: *

Please note:

Cancellations made with less than a 24 hour notice significantly limits our ability to make the appointment available for another patient in need. Appointment cancellations with less than 24 hours notice will incur a $42.00 charge. Grooming appointments with less than 48 hours notice will incur a $42.00 charge. Surgery/Specialist appointments with less than 48 hours notice will forfeit their deposit.

Please allow 24 hours for all medication refills and food order requests

Don’t forget about our 50% off Vaccine Day every Thursday! (only valid on rabies, distemper, and bordetella vaccines)

Save $$$ and enroll in our loyalty program, download the Pet Desk app and opt in to start earning discounts on services!

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Name

Appointment
Check-In Form

Appointment Check-In Form

Touhy Animal Hospital

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We Proudly Serve
Pets of Park Ridge, IL
and Beyond

AppointmentCheck-In Form

Appointment Check-In Form

Appointment
Check-In Form