LePar Animal Hospital
If you would like to make an appointment, you can expedite your check-in by submitting this form. Thank you for your cooperation in letting us assist you.
Form - New Client
First and Last Name (required)
Your Address (required)
Daytime Phone (required)
E-Mail Address (required)
Pet's Name (required)
Age: Years, Months (If known, or best guess)
Type of Pet(required)
Are your pet's vaccines current?
Please mail, fax, or bring your medical records at the time of your visit
Name of former veterinary practice:
May we request a transfer of records?
Reasons or conditions that prompted your visit?
Special requests or conditions?
Please list any additional pets here?
I understand, by indicating I agree and submitting this registration, that I am responsible for any charges incurred by my pet while in the care of the doctors at LePar Animal Hospital and that charges are due and payable at the time of service, unless other arrangements are made in advance. Any balance that is carried over a period of 30 days will accrue a monthly finance charge of 1.5% or 18% per annum. Any balance that I leave unpaid will be forwarded to LePar Animal Hospital's collection agency, and will incur a 25% collection fee for which I am liable, in addition to monthly finance charges.
I have read this statement and -
I Agree I Disagree
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If you have an emergency outside of our regular business hours, we recommend that you contact one of the following emergency facilities:
AETC at Emergency Veterinary Care South
13715 South Cicero Ave
Crestwood, IL 60445
Mon - Fri: 9am to Noon; 2pm to 7pm
Saturdays: 9am to 1pm; Sundays - Closed
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