New Client Form

Please contact us for an appointment prior to completing the New Client Information form to determine if we are accepting new clients.

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Thank you for choosing Church Hill Animal Hospital!

Please contact us for an appointment prior to completing the New Client Information form to determine if we are accepting new clients at this time. Thank you!

We look forward to providing care for your animal companion. Please help us get to know you and your companion by completing the following information before your first appointment. If you need immediate assistance, please call us directly at 804-644-8200. 
Please note: All fields marked with a * are required.

PROFESSIONAL FEES ARE DUE AT THE TIME SERVICES ARE RENDERED.

We will gladly prepare a written estimate if requested. We accept Master Card, Visa, cash and checks with ID. Returned checks will acquire a $35.00 processing fee. In the event this account is turned over for collection, the owner/agent is responsible for fees in the amount of 33 1/3% of the outstanding balance.

Animal Medical History

Please complete all information for each animal.
If yes, please list ALL medications your pet is currently taking, including heartworm preventative and flea medications.