URGENT NOTICE: Our ER is experiencing a high volume of cases. Please call ahead so we can talk you through your pet’s situation and prepare for your arrival.

Emergency Form

Complete your required form online from any device at any time before your visit that way we know what to expect on your arrival.

Get Started

Online Forms

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit. If this is an emergency, or if your pet needs urgent care, please call us at 716-646-4023 for a faster response.

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Cell Phone Number *

Home Phone Number (Landline)

Work Number

Email *

Date of appointment at the Village Veterinary Clinic of Hamburg? *

Time of appointment at the Village Veterinary Clinic of Hamburg? *

Pet Information

Name *

Breed *

Species *

Color *

Sex *

Male
Neutered Male
Female
Neutered Female

Date of Birth *

On any medications or supplements?

Up to date on Rabies vaccine? *

Yes
No
Unsure

Who is your regular veterinarian? *

How did you hear about us?

Are there any known allergies in your household- both human or pet? Food? Medication? We give treats in our exams, such as cheese and peanut butter. Please let us know of any allergies prior to exposure.

All payments are due at time of service and a deposit is required on all hospitalized patients with balance to be paid upon discharge. We accept Visa, Mastercard, Discover, Care Credit, or Cash. NO CHECKS.

Your records from today's visit will be faxed to your regular veterinarian. If you need any follow up care or refill of medications, please contact your regular veterinarian.

Signature *

Clear Signature

By signing I am acknowledging that I am financially responsible for payment of my pet(s) care. I also acknowledge that in the event of circumstances that result in non-payment I will be responsible for finance charges (2% monthly) and/or collection agency fees (34% of balance due).

Emergency Form

Online Forms

Pet Information

Our Contact Information!

Location

Contact Information

Hours

We're here for you!Please complete the form below, and a member of our team will get back to you as quickly as possible.

We're here for you!Please complete the form below, and a member of our team will get back to you as quickly as possible.