Name: Niles Animal Hospital & Bird Medical Center
Address: 7278 North Milwaukee, Niles, IL, 60714, US
Telephone: 847-647-8498
Price range: $$

New Canine Vaccination History

Client Name*
First Last
Client ID Number
Pet's Name*
Pet's ID Number
Breed*
Age*
Date of Last Rabies Vaccination*
Date Format: MM slash DD slash YYYY
Date of Last Distemper Vaccination*
Date Format: MM slash DD slash YYYY
Please give the approximate dates if your pet was vaccinated for any of the following:
Leptospirosis*
Date Format: MM slash DD slash YYYY
Lyme Disease*
Date Format: MM slash DD slash YYYY
Bordetella*
Date Format: MM slash DD slash YYYY
Date of Last Heartworm Test*
Date Format: MM slash DD slash YYYY
Do you use heartworm preventative?*
- Yes
- No
Do you use flea/tick preventative?*
- Yes
- No
Date of Last Fecal Examination*
Date Format: MM slash DD slash YYYY
Comments:

Visit Us Today!

7278 North Milwaukee
Niles, IL, 60714

Call/Text: 847-647-9325

Fax: 847-647-8498
Email: info@nilesanimalhospital.com

Book an Appointment

Get Directions

Hours

Monday: 8:00am-12:00pm & 2:00pm-6:00pm
Tuesday: 8:00am-12:00pm & 2:00pm-6:00pm
Wednesday: 8:00am – 4:00pm
Thursday: 8:00am-12:00pm & 2:00pm-6:00pm
Friday: 8:00am-12:00pm & 2:00pm-6:00pm
Saturday: 8:00am – 4:00pm
Sunday: Closed

*CLOSED EVERY OTHER WEDNESDAY AND EVERY OTHER SATURDAY*

Google Calendar