Lincoln Park

620 W Webster Ave. Chicago, IL 60614

Rogers Park

7001 N. Glenwood Ave. Chicago, IL 60626

773-327-5024
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- Lincoln Park
- Rogers Park
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New Client Registration

Name: Oz Animal Hospital
Address: 620 W. Webster Ave., Chicago, IL, 60614, United States
Telephone: 773-327-5024
Price range: $

Complete your new client paperwork online.

Fill out the form below and submit to complete your new client paperwork online. To complete this form on paper, download a printable PDF version using the Download button at the bottom of the page. Return it via email or bring it to your appointment. If you are having problems with either of these forms, please contact us directly.

Name *

First

Last

Preferred Pronouns

She/Her
He/Him
They/Them
Other

Please type in your preferred pronouns.

Additional Owner Name

First

Last

Preferred Pronouns

She/Her
He/Him
They/Them
Other

Please type in your preferred pronouns.

Primary Owner’s Phone *

Primary Phone Type

Home
Mobile
Work

Alternate Phone

Alternate Phone Type

Home
Mobile
Work

Is this the co-owner's phone?

Email *

Alternate Email

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Whom may we thank for referring you to us? *

Walk By/Sign
Yelp
Google Search
Facebook
Word of Mouth
Family/Friend Referral
Other

Please describe who referred you so we can thank them! *

Pet's Name *

Pet Species *

Canine
Feline

Sex *

Male
Neutered Male
Female
Spayed Female

Breed *

Date of Birth (or age) *

Color *

Is your pet microchipped? *

Yes
No
Unsure

Microchip Number

Are there any other pets in your household? *

Please describe. *

Does your pet ever go outside? *

Does your pet ever go to boarding or day care facility? *

Does your pet have any known allergies? *

Please describe. *

What animal hospital or rescue can we contact to get your pet's medical history?

Please list all your pet’s current medications and/or supplements:

Please list all prior illnesses/surgeries:

Please list your pet’s complete diet, including any and all treats:

What is the primary reason for today's visit? *

What is the primary reason for today’s visit?

Any additional comments?

I hereby authorize Oz Animal Hospital staff to examine and treat my pet as mutually agreed upon. I understand that payment for all fees are due at the time of service. *

Yes, I Authorize Treatment

We can’t help but want to spread the word about how adorable our patients are! Your signature here grants full permission to Oz Animal Hospital to utilize photographs, images, or videos of this patient and/or yourself (client information and patient medical conditions shall be kept confidential) for use in any publication, social media, or advertising medium. I waive all right of privacy or compensation in connection with any used images.

Yes, I authorize my pet's photo to be used.
No, I do not authorize my pet's photo to be used.

Cancellation Policies

Our Goal at Oz Animal Hospital is to provide quality medical care for your pet in a timely manner. In order to do so we have had to implement an appointment cancellation policy. The policy enables us to better utilize available appointments for our patients in need of medical care.

In order to be respectful of the medical needs of all patients, our practice will be requiring Doctor Appointment and Surgical Appointment deposits. The following fees and deposits will go into effect immediately:

Existing and New Client Appointment Deposit Of $95 At The Time Of Making The Appointment. This deposit will be applied as a credit to the bill at time of service. It is forfeited if the appointment is canceled within 24 hours of the appointment date. It will be transferred if the appointment is rescheduled prior to 24 hours of the original appointment date. Appointments may only be rescheduled once to avoid forfeiture of deposit. *

Yes, I Understand

Surgical Deposit Of $250 At Time Of Making The Appointment. This deposit is applied as a credit to the bill at time of service. It is forfeited if the appointment is canceled within 72 hours of the scheduled surgery drop-off time. It will be transferred if the surgery is rescheduled prior to 72 hours of the surgery date. Surgery may only be rescheduled once to avoid forfeiture of deposit. *

Yes, I Understand

Ultrasound Deposit Of $100 At Time Of Making The Appointment. This deposit is applied as a credit to the bill at time of service. It is forfeited if the appointment is canceled within 24 hours of the scheduled ultrasound drop-off time. It will be transferred if the ultrasound is rescheduled prior to 24 hours of the ultrasound date. The ultrasound may only be rescheduled once to avoid forfeiture of deposit. *

Yes, I Understand

Boarding Deposit Of $100 At Time Of Making The Appointment. This deposit is applied as a credit to the bill at time of service. It is forfeited if the appointment is canceled within 24 hours of the scheduled drop-off time. It will be transferred if the appointment is rescheduled prior to 24 hours of the surgery date. Boarding may only be rescheduled once to avoid forfeiture of deposit. *

Yes, I Understand

Late Arrival Policy for Appointments We understand that delays can happen, however we must try to keep the veterinarian and other patients on time. If you arrive 15 minutes past your scheduled time, we will have to reschedule your appointment for another day and time. *

Yes, I Understand

Signature *

Please type your name.

Date *

DOWNLOAD

We have two locations for your convenience!

Lincoln Park

620 W. Webster Ave.
Chicago, IL 60614

Phone: 773-327-5024
Text: 773-327-5024
Fax: 773-348-9867
Email: lincolnpark@ozanimalhospital.com

Hours:
Mon: 8 AM – 6 PM
Tue: 8 AM – 6 PM
Wed: 8 AM – 6 PM
Thu: 8 AM – 6 PM
Fri: 8 AM – 6 PM
Sat: 8 AM – 2 PM
Sun: Closed

CONTACT

Rogers Park

7001 N. Glenwood Ave.
Chicago, IL 60626

Phone: 773-327-5024
Text: 312-374-1944
Fax: 312-873-4451
Email: rogerspark@ozanimalhospital.com

Hours:
Mon: 8 AM – 6 PM
Tue: 8 AM – 6 PM
Wed: 8 AM – 6 PM
Thu: 8 AM – 6 PM
Fri: 8 AM – 6 PM
Sat: 8 AM –2 PM
Sun: Closed

CONTACT

We look forward to seeing you soon!

Request an appointment online by clicking the button below.

LINCOLN PARK

ROGERS PARK

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