North Shore Family Pet

New Client Form

We Treat Your Pet Like Family

We are honored that you have chosen North Shore Family Pet to care for your pets!

What is next? Please complete this online new client new patient registration form. When done, just press submit and it is sent directly to our Customer Service Desk. Within 24 business hours, a member of our staff will call you at your preferred number to schedule your first visit at NSFP. We are happy to meet you!

Yes, we’d love to welcome you!

We’re currently accepting new clients and are excited to meet you and your pet.

Please note that adult pet wellness exams, second opinions, and travel certificates are being scheduled approximately one month out at this time.

We are proud to be locally and independently owned since 2012

New Client Form

"*" indicates required fields

Phone

This field is for validation purposes and should be left unchanged.

Owner Name*

First Last

Owner Address*

Street Address Address Line 2 City State ZIP Code

County owner resides in?*

Lake

Cook

Other

Owner Email*

Work Phone

Home Phone

Cell Phone

Which number is preferred for reminders/callbacks?*

Would you like to add a Co-Owner?*

Yes

Co-Owner Name

First Last

Co-Owner Phone

How did you hear about our practice?*

Whom may we thank for referring you to our practice?

Do you have pet insurance?*

Yes

If "Yes" above please let us know which Insurance Company

Pet Information

Patient Name*

Dog or Cat?*

Birth Date*

Sex*

Male

Female

Spayed or Neutered?*

Yes

Breed*

Color*

Is your pet microchipped?*

Yes

Unknown

When/Where did you obtain your pet?*

Patient History

Referring Veterinarian*

Primary Veterinarian*

Upload patient medical files

Drop files here or

Accepted file types: pdf, doc, jpg, png, Max. file size: 60 MB.

Reason for visit*

Please list any medications you are giving:*

Please list other known medical conditions:*

Please list any allergies/vaccine reactions:*

Are there other pets in your household? Indicate how many and pet type:*

Photo/Social Media Release*

Yes

North Shore Family Pet would like your permission to take and post photos of your pet on their Social Media pages.

Name

First Last

Signature

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Hours of Operation

Mon – Fri: 8AM – 5PM

Sat: 8AM – 12PM

Sun: CLOSED

Monday - Friday	8:00 am - 5:00pm
Saturday	8:00 am - 12:00pm
Sunday	Closed