Client Forms & Clinic Policies

PLEASE NOTE:
DUE TO A SIGNIFICANT INCREASE IN NEW CLIENTS LOOKING TO TRANFER CARE TO US
NEW PATIENT WELLNESS APPOINTMENT AVAILABILITY MAYBE LIMITED.

If your pet requires more prompt medical attention due to an illness or injury, please note this under "the reason for visit"
Please contact our office if you do not receive a response within 24 hours.

Pet Owner Information

Spouse/Partner or Relative's Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Secondary Phone Number *

Patient Information

Patient #2 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

Vaccine History/Dates? *

YOUR DIGITAL SIGNATURE BELOW ACKNOWLEDGES THAT YOU HAVE READ AND AGREE TO ALL TERMS

Please Acknowledge *

I have read and agree to adhere to clinic policies I understand the appointment & prescription policy I understand my payment options I have read and agree to adhere to the code of conduct

Upon request estimates will gladly be provided to you via email prior to your pet's appointment(s)
All fee's must be paid in full at time of service.

All of our patients are superstars! We would love to have your permission to take their picture for our medical records, social media pages and website. No personal information is ever shared. Do you give us permission to take photo(s) of your pet(s)?

Photo Release *

I DO consent I do NOT consent

PLEASE EMAIL US YOUR PET'S PREVIOUS MEDICAL RECORDS
vet.churchville@gmail.com

Many veterinary practices across the United States and beyond are facing the challenge of having limited licensed veterinary professionals while also being inundated with a stream of cases both urgent and non-urgent. Churchville Veterinary Hospital P.C. is taking remarkable efforts behind-the-scenes to balance these high demands for veterinary care with our day-to-day capabilities.
Your patience and cooperation is appreciated.

Thank you for choosing Churchville Veterinary Hospital P.C. If you have any questions, please don't hesitate to give us a call.

Forms & Policies

Clinic Policies

New Client Request Form

Pet Owner Information

Patient Information

Patient #2 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

Hospital Forms
These can be printed, filled out and brought with you to your pet's appointment

Dental Options Form

CPR Consent Form

Small Mammal History Form

Office Hours

Get in Touch With Us

Helpful Info

Forms & Policies

Clinic Policies

New Client Request Form

Pet Owner Information

Patient Information

Patient #2 InformationIf you have more than two pets pets we will collect additional patient information from you at or before your pet's first visit

Hospital FormsThese can be printed, filled out and brought with you to your pet's appointment

Dental Options Form

CPR Consent Form

Small Mammal History Form

Office Hours

Get in Touch With Us

Helpful Info

Patient #2 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

Hospital Forms
These can be printed, filled out and brought with you to your pet's appointment