Name: Countryside Animal Clinic PC
Address: 4091 Dundee Road, Northbrook, IL, 60062, United States
Telephone: 847-498-5567
Price range: $

Curbside Check-In Form

Thank you for choosing Countryside Animal Clinic PC!

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Curbside Check-In Form

Before you come to see us, complete your curbside check-in form online. When you arrive for your appointment, call us at 847-498-5567, and a member of our team will come out to retrieve your pet(s). If you have not booked an appointment yet, please schedule an appointment here.

Please Note: Our updated COVID-19 policy requires us to let you know the symptoms to be aware of before coming into your appointment. If you are suffering from ANY of the following: coughing, fever, upper respiratory, headache, or gastrointestinal issues, any international travels, or travels by airplane to hotspots within the US, etc., your pet’s appointment will need to be rescheduled or another person needs to bring your pet in for the appointment. A mask is always required.

Curbside Questions

I am in this vehicle: *

(Please list the model and color.)

Best phone number for today's appointment: *

(The veterinarian and technician will use this number to communicate with you through the appointment.)

Patient's Name *

Patient's Species *

Dog/Canine
Cat/Feline

Owner's Name *

First

Last

Appointment Date/Time *

Date

Time

Primary Reason for Appointment / Concern (please be as detailed as possible) *

Patient's Energy Level

Normal
Increased
Decreased

Please list the medications your pet is currently taking:

Do you need refills of any of these medications?

If you need a medication refill, please list which medications:

Do you need refills on any prescription pet food?

If you need a prescription pet food refill, please let us know which kind:

Patient's Appetite

Normal
Increased
Decreased

Drinking/Water Intake

Normal
Increased
Decreased

Is the patient coughing?

If yes, for how long?

Is the patient sneezing?

If yes, for how long?

Is the patient vomiting?

If yes, for how long?

Please upload any relevant records or photos below:

Click or drag files to this area to upload. You can upload up to 5 files.

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Hours

Mon - Fri: 8 AM to 6 PM
Sat: 8 AM to 12 PM (Noon)
Sun: Closed

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Contact

Email: info@countrysideanimalclinic.com
Phone: 847-498-5567
Fax: 847-498-2196

After-Hours Emergencies:

Blue Pearl Veterinary Partners in Northbrook: 847-564-5775
Veterinary Specialty Center in Bannockburn: 847-459-7535
Veterinary Emergency Group: 847-754-3996

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Location

4091 Dundee Road
Northbrook, IL 60062

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