Appointment Request
and Client Forms

You can request an appointment with us using our online form provided below. You can also find our new client form, which we highly recommend filling out before scheduling your first appointment. If you scheduled a boarding reservation, you can find our boarding form as well, which includes important information about our boarding policy and questions you need to answer about your pet.

For any questions about our forms, please call Lindenhurst Animal Hospital at (847) 356-1516!

Request an Appointment

Appointment Request

Name *

Name

First

Last

Phone *

Email *

Address *

City *

US States *

Zip *

Pet's Name *

Pet Species *

Reason for Appointment *

1st Choice Day *

Time of Day *

2nd Choice Day *

Time of Day *

3rd Choice Day *

Time of Day *

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If you are human, leave this field blank.

New Client Form

Name *

Name

First

Last

Spouse

Address *

City *

US States *

Zip *

Phone *

Cell Phone

Email *

Email Reminders *

Yes

How did you hear about us? *

If referred by someone, Who referred you?

If you are human, leave this field blank.

Boarding Form

Name *

Name

First

Last

Address *

Address

City

State

Zip

Phone *

Email *

Emergency Number *

Who are we contacting? *

Emergency Number

Who are we contacting?

Drop off Date *

Pick up Date *

Pet Name *

Species *

Breed *

Age *

Sex *

Vaccinations & Testing: In order to protect the health of your pet, and others, this facility requires documentation showing that all boarding dogs have current rabies, DA2PP/DA2PPL, H3N2/H3N8, Bordetella vaccines, annual fecal testing, and heartworm/Lyme test; and cats have current rabies and FVRCP/FVRCPC vaccines, annual fecal testing, and leukemia vaccine or testing. If any of your pets’ vaccinations are past due, they must be inoculated before boarding. It is preferred that vaccinations are completed two (2) weeks prior to boarding for best protection. Vaccines that must be administered at this facility will be added to your bill. Pets that are so young that they have not completed their entire series of vaccinations, or pets that have health concerns so that they are not current on vaccinations may not be protected and, thus, will be housed in isolation at an additional charge. Owners accept any risks of infection.
External Parasites: Each pet will be evaluated upon arrival for external parasites (fleas, ticks) and if found at any time will be treated at the owners expense.
Bedding: We provide freshly laundered bedding that will be changed at least once daily; however, in the event it is found that the pet is chewing/eating the bedding then all bedding will be removed and none will be offered for the duration of the pets remaining stay. Any treatment will be at the owners expense. You may leave your own bedding; however, we can not be held responsible for the replacement or return of personal belongings.
Toys/Bones: Toys and chew bones are welcome. We also have some that they can play with. Toys/bones may not be left with them all of the time if we feel they may destroy the toy or swallow the bone. Any treatment will be at the owners expense. We can not be held responsible for the replacement or return of personal belongings.
Carriers/Leashes/Collars: All collars will need to be removed. Please do not leave collars and leashes with us. We can not be held responsible for the replacement or return of personal belongings. If your dog uses a head halter and is more comfortable being walked with one you may leave it with us.
Diet: We recommend bringing your regular food; however, if you are unable to, we feed Science Diet Sensitive Stomach.When a pet's diet is suddenly changed it can cause intestinal upset such as vomiting and/or diarrhea. Please label food with your pet's name and your last name and provide accurate feeding instructions as well as what brand of food your pet eats. Be sure to provide enough food for your pet's stay with us as well as a few extra days worth. If your pet does run out of food we will attempt to purchase the food locally at your expense.
Stress/Anxiety: Boarding can be a stressful time for your pet. Especially if they do not board frequently. It is common for them to have loss of appetite, soft stools, diarrhea, vomiting, or become withdrawn. Some become agitated digging or biting at their enclosures. Some pets do better staying in their own homes and having someone come by or stay with them. If your pet is exhibiting signs of anxiety we will add feliway for cats or adaptil for dogs. Additional treatment may be needed on an individual basis at the owners expense.
Times Devoted to Pets: Staff will walk dogs three (3) to four (4) times daily. All boarding pets will be checked on multiple times daily. We do not have staff here twenty-four (24) hours a day. If you feel your pet needs more attention then what we can provide you may need to locate a different facility to meet your needs.
Abandonment: In the event that you do not pick up your pet within three (3) days of the date listed on the boarding agreement and do not notify us within that time frame, we may assume the pet is abandoned and are hereby authorized to relinquish the pet to the county shelter as we deem best and/or necessary.
Release of Pet: For safety, we will only release your pet to the owner. If someone else will be picking up your pet then you must notify us in writing and make arrangements. The alternative agent may be required to show picture identification for us to release your pet.
Bathing: If your pet is scheduled for a bath, please be aware that pick up time is between 4:00-6:00pm. This is to allow for adequate drying time.

Date of Rabies

Distemper Booster

Bordetella/Leukemia

Date of H3N2

H3N8

Flu Combo H3N2/H3N8

Fecal

Date of Last Dose of Heartworm Prevention

Type

Date of Last Dose of Flea Prevention

Type

Name of food fed *

Amount *

Frequency *

Personal Items

Playtime

Yes

For an additional fee pets can have extra one on one time with a staff member. This may include playing with toys, petting, walks. This may be with a housemate provided the animals are enjoying each others company. Sometimes this helps anxious dogs to better eat and enjoy their stay.

Bathing: Some pets do not stay clean during boarding so would you be interested in having your pet bathed before going home?

Yes

If yes, please beware that pick up time is between 4:00-6:00pm to allow for adequate drying time.

Has your pet been around any other animals, boarded, groomed, or at day care during the last month?

Yes

If yes explain?

Any situations where your pet may become anxious or afraid?

Yes

If yes, conditions when could occur

Recent Activity: How has your pet been doing the past month, to include appetite, elimination, behavior changes, weight changes, skin conditions or any other concerns?

Is there anything specific that you would like a veterinarian to address during your pets stay?

Medical Conditions: Please list all conditions your pet has, even if they are currently controlled.

List any medications to be given during your pets stay

Concerns During Boarding: Should your pet not be drinking an appropriate amount of water fluids may be administered subcutaneously. If there is inappetance we may add a different food, change the food, force feed, or provide appetite stimulants. If there is soft stool or diarrhea we may evaluate for parasites and if finding any treat appropriately. If we do not find parasites then the soft stool or diarrhea will be treated at the discretion of a veterinarian. Especially for pets who have not boarded with us before if your pet is having concerns we may contact you to see if there is someone, who the pet likes, who may be able to visit or take the pet home to see if will do better in a more familiar environment.

If we can not reach your emergency contact how do you want us to proceed?

Please do whatever is needed.

Please do whatever is needed up to $Please do whatever is needed up to $

Please call for permission to do anything that is needed.

Please make sure if you are not the emergency contact that you have spoken to your emergency contact and they understand what your wishes are should there be a concern with your pet. As the owner or authorized agent you are aware that any charges for examinations, diagnostics, or medications are in addition to boarding fees.

I certify that I own or am the authorized agent of the above described animal. Lindenhurst Animal Hospital and its staff cannot guarantee the health of any animal, but pledge to provide appropriate care for all boarders in their facility. While under our care and supervision we will use all reasonable precaution against injury, escape, or death of your pet.

I have read the boarding policy and understand the hospital's policies.

Signature *

Clear

Date *

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Appointment Requestand Client Forms

Appointment Request
and Client Forms