New Client Information

Please fill out the form below

We are glad you have chosen Glencoe Animal Hospital. In order to help us speed the process of registering and caring for your pet, please provide all of the following information and click to submit. This will ensure your information is captured in our client database.

Name:

Spouse's Name:

Address:

City:

Zip Code:

Home Phone:

Cellphone:

Spouse's Cell Phone:

Work Phone:

Spouse's Work Phone:

Email:

Spouse's Email:

Which number is your primary number (the number you can best be reached at)?

How were you referred to Glencoe Animal Hospital?

Please list all the pets in your household:

#

1
2
3
4
5

Pet's Name

Dog or Cat

Age

1820 Skokie Blvd
Northbrook, IL 60062

Phone: (847) 835-1302
Fax: (847) 835-8854

Email Us

Tues - Thurs: 9:00am -5:30pm
Mon and Fri: 9:00am-6:00pm

Sat: 9:00am - 1:00pm
Sun: Closed
After hours: BLUE PEARL
Call (847) 564-5775

Financial Policy and Records Release

Thank you for choosing Glencoe Animal Hospital for your pet care needs. We are dedicated to providing the highest quality care to all of our patients.

In order to provide you services with the highest level of quality, we cannot extend credit out of our office. Please understand that payment in full is due at the time of service. We may also require a deposit for major procedures. To help you obtain your financial responsibility, the following payment options are accepted.

Payment Options

Cash/Check: We accept payment by cash or check at the time of service.

Bank Credit/Debit Card: We accept payment by MasterCard, Visa, Discover and American Express.

In an effort to offer our clients more personalized financial arrangements, we are pleased to offer Care Credit. If you wish to take advantage of this payment plan, please ask one of our staff members for an application.

New Client Information

Please fill out the form below