New Client Form

At Round Lake Animal Hospital, we offer this form online so you can complete them in the convenience of your own home or office.

As a First time Client, you can get a 15% discount on your first *Wellness Exam. Just make sure you ask the Receptionist about getting your discount applied at the time of Check Out!

* Discount ONLY applies to the Wellness exam, it does not apply to any Medications or Treatments.

Co-Owner Name (first & last):

Co-Owner Phone Number:

Patient Information:

Pet's Name

Age / DOB

Species

Breed

Color

Sex

Female Intact

Female Spayed

Male Intact

Male Neutered

General Information

Previous Veterinarian and Phone Number

How did you hear about us?

Internet Search

Drive By

Client Referral

Other

If you were referred by a client, what is their name?

I understand that my pet’s picture may be used on social media sites.

YES, you can use my pet's photo on social media.

NO, do not use my pet's photo on social media.

Reason for your pet's visit:

Round Lake Animal Hospital

24431 IL-134
Round Lake, IL 60073

phone: (847) 546-6700
email us

Veterinarians serving the Round Lake, IL area, including (but not limited to): Grayslake, Waukegan, Round Lake Beach, Round Lake Park, Libertyville, and Lake Forest.

Make an Appointment