Protect your pet against Canine Respiratory Disease! Click here to learn more!
"*" indicates required fields
I hereby give Bensenville Animal Hospital permission to take photographs of me and/or my pet for the purpose of posting on Facebook, Clinic Website, and/or other social media outlets. I choose to release and discharge Bensenville Animal Hospital from any and all claims arising out of the use of the photos.
To the best of my knowledge, the information provided above and on the patient history form is accurate and complete. I certify that I am above the age of 18 and am the authorized agent/owner of said pets and can make medical decisions on their behalf. I authorize you to contact my referring veterinarian if clarification of medical history is needed or to acquire previous veterinary records, I understand that payment is due at the time services are rendered. I agree to pay all charges at the time my pet is discharged and I am responsible for any legal fees incurred in collecting any unpaid balances.
Make an Appointment
Pharmacy
Find Us