New Client Form

Save time by filling out your forms online! Please use the form below to request an appointment online. If you need immediate assistance, please call us directly at 217-974-4681.

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New Client/Appointment Form

Name *

First

Last

Email *

Primary Phone *

Secondary Phone

Preferred Contact Method *

Text
Email

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Who else is authorized to make decisions about your pet's healthcare? *

First

Last

Phone

How did you find out about our hospital? If you were referred by someone, who should we thank? *

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Color *

Age/Date of Birth *

Pet's Weight (in lbs) *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

What is the microchip number?

Would you like to add a second pet for this visit?

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Color *

Age/Date of Birth *

Pet's Weight (in lbs) *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

What is the microchip number?

Would you like to add a third pet for this visit?

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Color *

Age/Date of Birth *

Pet's Weight (in lbs) *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

What is the microchip number?

Would you like to add a fourth pet for this visit?

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Color *

Age/Date of Birth *

Pet's Weight (in lbs) *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

What is the microchip number?

Would you like to add a fifth pet for this visit?

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Color *

Age/Date of Birth *

Pet's Weight (in lbs) *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

What is the microchip number?

What day would you prefer an appointment? (check all that apply) *

Monday
Tuesday
Wednesday
Thursday
Friday

What time of the day do you prefer? (check all that apply) *

8 am -10 am
10 am – 12 pm
12 pm – 2 pm
2 pm – 4 pm

What is the reason for your visit? *

Please read our policies below before submitting your appointment request.

Cancellation policy.
Payment policy.

Policies *

I have read and understand the payment and cancelation policy.

Payment is due in full at the time that services are performed. We accept Visa, MasterCard, and Discover payments. We neither extend credit, nor bill for services. All open invoices are sent to collections after 45 days unless prior arrangements are made. Visit our payment options page for more information.

I have read and accept the financial policy.

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Make an appointment!

HomeVet proudly serves the communities of Champaign, Urbana, Savoy, St. Joseph, Sydney, and Mahomet., and beyond. Click the button below to schedule an appointment online!

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Have a question?

Complete our online form and we will be in touch shortly!

Contact

P: 217-974-4681
E: [email protected]

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Hours

Mon – Fri: 8:00 am to 4:00 pm
Closed: Sat, Sun, all major Holidays

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First

Last

Email *

Phone

How can we help you? *

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