Filling Out Client Forms Prior To Visit

Online Patient and Client Forms

If you need to fill out a form for your pet, you can complete it right here on our website at your convenience. Just find the form you need, fill out all the required fields, and click the submit button to send the form to our front desk team.

Let us know if you have any questions by calling (773) 631-6727!

New Client Form

New Client Form

Client Information

Name
Name
First
Last
Address
Address
City
State/Province
Zip/Postal
Best Phone Selection
Spouse / Significant Other
Spouse / Significant Other
First
Last

Pet Information

plus1 Add another pet minus1 Remove a pet
I give consent to Abell Animal Hospital to post photos of my pet on their social media accounts (such as Facebook and the website):
All fees are due at the time of service. Unfortunately, we do not offer payment plans. We do accept Visa, MasterCard, Discover, American Express, cash/check & Care Credit.

Pre-Visit Questionnaire

Pre-Visit Questionnaire
Owner's Name
Owner's Name
First
Last
As a Fear Free Certified Professional team, we want to make your pet’s veterinary experience as enjoyable and as stress free as possible. As such, it’s important for us to understand what your pet might find upsetting. The information will help us to adjust our care to better serve and comfort your pet. Please answer the following questions to the best of your ability so we can take into consideration both you & your pet’s preferences.
Does your pet show any reluctance to getting in the carrier or car?
During travel to the veterinary hospital, does your pet do any of the following:
Does your pet prefer
Check any situations listed below that your pet has shown avoidance or dislike of in the past. You can add additional comments at the end of this form.

Medical History & Health Questionnaire

Medical History & Health Questionnaire
Owner's Name
Owner's Name
First
Last

Has your pet experienced any of the following since your last hospital visit?

Vomiting
Diarrhea
Lethargy
Scooting
Scratching
Growths
Any abnormalities
Ear irritations
Coughing
Skin conditions/Hair loss
Runny nose or eyes
Have you been administering heartworm, flea, and tick prevention?
Do you need a refill of any medication or food?

Maximum file size: 52.43MB

By checking this box and typing my name, I authorize an electronic signature.

Surgical Consent Form

Surgical Consent Form
Owner's Name
Owner's Name
First
Last
Sex
Vaccines Current?
Has patient been given aspirin in the last 7-14 days?
Was food or water given after 10:00 PM?
If my pet has a serious illness or injury, and in the event such illness or injury becomes critical during my absence, I want the doctors and medical team to
I also authorize Abell Animal Hospital to perform such diagnostic, therapeutic, and surgical procedures that are in their opinion necessary and advisable to maintain my pet’s health. Including, but not limited to the administration of anesthesia, and the services involving pathology and radiology. The nature of such services has been explained to my satisfaction and I accept all procedures to be done to the best of the abilities of the hospital staff. I realize that no guarantee or warranty has ethically or professionally been made regarding the results or cure. I acknowledge that my pet will be discharged only during regular office hours, when doctors, technicians, and receptionists are present. It is understood that the actual cost may exceed the estimated amount. Payments will be completed in full at time of release.
I grant Abell Animal Hospital permission to post my pet’s picture, story and medical information on social media
I grant Abell Animal Hospital permission to send text message updates to my cell phone number (carrier charges may apply)

Dental Surgical Consent Form

Dental Surgical Consent Form
Owner's Name
Owner's Name
First
Last
Sex
Vaccines Current?
Has patient been given aspirin in the last 7-14 days?
Was food or water given after 10:00 PM?
If my pet has a serious illness or injury, and in the event such illness or injury becomes critical during my absence, I want the doctors and medical team to
I also authorize Abell Animal Hospital to perform such diagnostic, therapeutic, and surgical procedures that are in their opinion necessary and advisable to maintain my pet’s health. Including, but not limited to the administration of anesthesia, and the services involving pathology and radiology. The nature of such services has been explained to my satisfaction and I accept all procedures to be done to the best of the abilities of the hospital staff. I realize that no guarantee or warranty has ethically or professionally been made regarding the results or cure. I acknowledge that my pet will be discharged only during regular office hours, when doctors, technicians, and receptionists are present. It is understood that the actual cost may exceed the estimated amount. Payments will be completed in full at time of release.

DENTAL INFORMATION

Please note that at the time of dental cleanings we complete an examination of the mouth under anesthesia. This is done after teeth have been scaled (cleaned) to remove calculus accumulation. During this examination we can better determine the need for teeth to be extracted. We ask that you indicate to us whether or not we have your consent to extract diseased or injured teeth. This ensures that we proceed with the necessary treatments as you see fit for your pet in your absence. Please take the time to indicate your preference below and call us if you have any additional questions or concerns.
I grant Abell Animal Hospital permission to post my pet’s picture, story and medical information on social media
I grant Abell Animal Hospital permission to send text message updates to my cell phone number (carrier charges may apply)

Euthanasia Consent Form

Euthanasia Consent Form
Owner's Name
Owner's Name
First
Last
Address
Address
City
State/Province
Zip/Postal
Sex
I, the undersigned, do hereby certify that I am the owner (duly authorized agent for the owner) of the animal described above; that I do hereby give Hospital Owner, DVM, his agents and representatives full and complete authority to euthanize the said animal for humane reasons, and in whatever manner the said Doctor, his agents, or representatives shall deem fit.
I do hereby, and by these presents forever release the said Doctor, his agents, or representatives from any and all liability for so euthanizing the said animal. I give authorization to dispose of the remains in accordance with the hospital’s policy and by complying with all legal requirements of the state of Illinois, unless otherwise instructed.
I do hereby, and by these presents forever release the said Doctor, his agents, or representatives from any and all liability for so euthanizing the said animal. I give authorization to dispose of the remains in accordance with the hospital’s policy and by complying with all legal requirements of the state of Illinois, unless otherwise instructed.
By checking this box and signing my name, I authorize an electronic signature.