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.

New Pets- Canine Rehabilitation & Rehabilitation Form

Save time during your next appointment! Complete your required forms online from any device at any time before your visit.

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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 *

Home Phone

Work Phone

Email *

Name of spouse, partner, or other person you would like on the account. Please include name, cell phone, or other contact information for this person.

Pet Name *

Pet Breed *

Species *

Date of Birth

Sex *

Male
Neutered Male
Female
Spayed Female

Up to date on Rabies vaccine? *

Yes
No
Unsure

Who is your regular veterinarian? *

How did you hear about us? *

If you were referred by a veterinarian (who is not your regular veterinarian), please list their name/hospital)

Why are you seeking canine rehabilitation or pain management? *

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

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

Do you have any known allergies in your household- either human or pet? Food? Medication? We give treats during our sessions, such as cheese or peanut butter. Please, let us know if anyone has allergies prior to exposure. *

Please note - in order to protect our unique PT equipment and materials from damage IF your pet is in need of a nail trim it will be done by the PT team (client is responsible for the charge associated with this service). If your pet is experiencing any type of skin or gastrointestinal issues they cannot come in for PT until the issues have been resolved.

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

Please download our FREE pet app, PetDesk!

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New Pets- Canine Rehabilitation & Rehabilitation Form

Online Forms

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.