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New Client Form

Please complete our New Client Form using one of the options below if your pet is a new patient at Pekin Veterinary Clinic.

Request Appointment
Option 1

Complete Online

Fill out and submit the online form below.

Option 2

Complete on Arrival

If you prefer, complete the form when you get to our hospital.

New Client Form

Owner Information

Emergency Contact

Patient Information

Primary Veterinarian Information

Please fill this section in if we are not your primary care veterinary hospital. By listing your primary care veterinarian, you are authorizing Pekin Veterinary Clinic to release patient information to the primary care hospital or veterinarian.
By submitting this form, I hereby authorize Pekin Veterinary Clinic to render medical care for my pet(s) as deemed necessary by the veterinarian. I understand that no guarantee can be given to the outcome of treatments and take it as my responsibility to comprehend any risks involved. I agree to pay for the cost of all services to which I consent to by written or verbal estimate. I understand that a deposit is required before diagnostics and treatments can be initiated and that payment in full is required prior to discharge of patient from Pekin Veterinary Clinic.

Caring for Pets in Central Illinois

Pekin Veterinary Clinic is welcoming new clients to our clinic. Contact our team to book your pet's appointment.

Contact Us

Contact (309) 346-1375