217-483-6000 info@thevillageveterinarian.com

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Curbside Check-In Form

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Thank you for taking the time to complete this form before your appointment!

If you have any questions, give us a call at 217-483-6000. Please Note: All fields with * are required.

Curbside Check-In/Drop-Off Form

I am in this vehicle: *

(Please list the model and color.)

Best phone number for today's appointment: *

Email *

Patient's Name *

Patient's Species *

Canine
Feline

Owner's Name *

First

Last

Appointment Date/Time *

Date

Time

Primary Reason for Appointment / Concern (please be as detailed as possible) *

Patient's Energy Level

Normal
Increased
Decreased

Please list the medications your pet is currently taking:

Do you need refills of any of these medications?

Yes
No

If you need a medication refill, please list the medications that need to be refilled below:

Patient's Appetite

Normal
Increased
Decreased

Drinking/Water Intake

Normal
Increased
Decreased

Is the patient coughing?

Yes
No

If yes, for how long?

Is the patient sneezing?

Yes
No

If yes, for how long?

Is the patient vomiting?

Yes
No

If yes, for how long?

Are your pet’s bowel movements normal or abnormal?

Normal
Abnormal

(Please Note: Normal feces is solid logs {think tootsie roll candy} that are not too hard and easy to pick up. Anything else is not normal though your pet may have a different type of bowel movement that is all you’ve seen from them.)

Please describe feces (if not normal).

What are you feeding your pet (brand, wet or dry, etc.)? Please be specific if possible & include how much you feed and how often each day you feed.

If you have a kitty, please let us know if kitty is indoors exclusively, outdoors exclusively or both in and outside. You can provide more information if you wish such as “only goes out on the patio when I’m with her."

I understand that financial responsibility for services rendered is payable at the time of discharge. I have reviewed the treatment plan and estimate provided to me by The Village Veterinarian staff, and my signature below indicates my approval of the treatment plan. *

I have read and understand.

Signature *

Clear Signature

Please upload any relevant photos, videos, or records here:

Click or drag a file to this area to upload.

Please upload any additional relevant photos, videos, or records here:

Click or drag a file to this area to upload.

Please upload any additional relevant photos, videos, or records here:

Click or drag a file to this area to upload.

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Are you ready for a visit to see us?

Requesting an appointment is easier than ever! Call us during business hours at 217-483-6000, and we'll be there to help you get your pet's visit scheduled. We look forward to seeing you soon!

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Download our app and connect with us on PetDesk!

Keeping up with your pet’s health from your mobile device has never been easier! With our new app, you’ll have all of your pet’s health information in the palm of your hand. Consider it your pet’s personal organizer app. Best of all, it’s free! Plus, you’ll be able to communicate with our team easily. On the app, you can:

Request Appointments 24/7
Access Your Pet’s Medical Records
Organize all of Your Pet’s Important Information
Receive Automatic Reminders
Save Notes, Pics, and Much More
Two-Way Texting With Our Team

Compassionate Veterinary Care in Chatham, IL

Since 1996 we have delivered superior patient care, convenient service, a clean and comfortable environment, and prompt attention with minimal waiting.

Compassionate
Veterinary
Care in Chatham, IL

Since 1996 we have delivered superior patient care, convenient service, a clean and comfortable environment, and prompt attention with minimal waiting.



Location

306 North Main
Chatham, IL 62629



Hours

Monday - Friday: 8:30 AM - 5 PM
Saturday - Sunday: Closed

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Contact Info

Phone: 217-483-6000
Email: info@thevillageveterinarian.com

Have a question?

We're here to help! Please use the form below to send us a message, and we'll get back to you as quickly as possible. If you need immediate assistance during business hours, please call our clinic directly at 217-483-6000.

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