Client Forms & Clinic Policies

CVH believes that effective veterinary care relies on a respectful, collaborative relationship built on trust and communication between client, staff and Doctor. We value our clients, care deeply for our patients, and take great pride in serving our community.

Churchville Veterinary Hospital P.C. Policies

A complete copy of our policies is available by email upon request. Please contact us if you would like a copy

New Client Application

Current Accepting Status:
As our patient family naturally changes over time through relocation, life transitions, and the loss of beloved pets, we are occasionally able to welcome a limited number of new patients each month.
At this time, our new patient appointments are intended for wellness and preventive care only.

Thank you for choosing Churchville Vet

Pet Owner Information

* Indicates required field

How did you hear about us? *

Internet search A friend or family member Other

Who can we thank for referring you? *

Pet Owner's Name *

First

Last

Primary Phone Number *

Preferred Method of Contact *

Text Email Phone Call

Primary Address *

Line 1

Line 2

City

State

Zip Code

Country

Best Email *

Secondary Owner's Name if Applicable *

First

Last

Secondary Phone Number *

How many pets do you have? *

Previous Veterinary Clinic, if any *

Your Pet's information

Your Pet's Name *

Pet's Date of Birth *

Species *

Sex *

Has your pet been spayed or neutered? *

Breed (if unknown put unknown/mix breed and size) *

Color/Markings *

Microchip # (if applicable) *

Vaccine History/Dates? *

Does your pet have any known health conditions or issues? Recent surgeries? *

Is your pet on any medications? *

Describe the reason for your pet's visit *

Second Pet's Information
If you have more than two pets pets we will collect additional patient information from you at or before your pet's first visit

Pet's Name *

Pet's Date of Birth *

Species *

Sex *

Is your pet spayed or neutered? *

Pet's Breed *

Color/Markings *

Microchip number (If applicable) *

Vaccine History/Dates? *

Does your pet have any known health conditions/concerns? Surgeries? *

Is your pet on any medications? *

Describe the reason for this pet's visit *

Notes/Comments/Other Information that you think we should know *

YOUR DIGITAL SIGNATURE BELOW ACKNOWLEDGES THAT YOU HAVE READ AND AGREE

Please Acknowledge *

I have read & agree to clinic policies

I give Churchville Veterinary Hospital permission to take and use photos of my pet(s) for clinic-related purposes, including our website, social media, and other promotional materials. I understand that photos may be used without additional notice or compensation. No personal information is ever shared.

Photo Release *

Yes, I give permission No, I do not give permission

Your digital signature below confirms that the information provided is accurate to the best of your knowledge and you agree to follow Churchville Veterinary Hospital’s policies. You understand that we may decline or discontinue a VCPR if our veterinarian determines that your pet’s medical needs are not a good fit for the level of care we are able to provide

Digital Signature *

SO THAT WE CAN BEST ASSIST YOU
PLEASE EMAIL US YOUR PET'S PREVIOUS MEDICAL RECORDS
THANK YOU
 [email protected]

Submit

Please allow 48 hours for an email reply on your application. If you have not heard back from us within 48 hours of submitting a new client form please contact us

NEW Office Hours

Monday 8:00am - 5:00pm
Tuesday 8:00am - 5:00pm
Wednesday 8:00am - 5:00pm
Thursday 8:00am - 5:00pm
Friday-Sunday: CLOSED

CLOSED for most Federal Holidays

After Hours / Emergency Information

88 South Main St.
Churchville, NY 14428
Phone: 585- 293-2270
Text: 585-531-1589
Fax: (585) 293-2294
E-mail: vet.churchville@gmail.com

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New Client Application &​Clinic Policies