Thank you for giving the team at Burr Ridge Veterinary Clinic the opportunity to care for your animal companion. To help make check-in faster, please complete the following Patient History Form at least two days prior to your pet’s appointment.

You may complete the web form and submit it online below or click the Download PDF Version button to download the form and submit it to [email protected].

How to download and email the PDF form:

  • Open the fillable PDF version of the form by clicking the button below.
  • Download the blank form to your computer.
  • Complete the fillable PDF form using your computer’s PDF reader program
  • Save the completed form as a new file and e-mail it to [email protected] as an attachment.

If you have any questions or issues with the form, please call us at 630-598-0600.

Download PDF Version

Patient History

Please share your observations of your pet's condition below

My pet's problem is
My pet's appetite has

Is your pet currently taking any medications or supplements

What is your pet's travel history?

Does your cat have access to outdoors or other outdoor cats?
Patient Symptoms
Coughing
Sneezing
Weight loss
Excessive Water Consumption
Excessive Urination
Vomiting
Diarrhea
Does Your Pet Have a Microchip
Is Your Pet Current on Parasite Control?
If yes, check all that apply:
Does Your Pet Receive Regular Dental Care?
If so, What (check all that apply)?
Does Your Pet Have Any Vaccines Due (check all that apply)?
Please indicate if your pet currently has any of the following symptoms.