• Client Information

    NO CHECKS ACCEPTED
  • Date Format: MM slash DD slash YYYY
  • Pet Information

  • Social Media Consent

  • I hereby give Emergency Pet Hospital of Redlands permission to take photographs and videos of my pet for purposes of posting to any/all social media accounts including, but not limited to Facebook, Twitter, Snapchat, Instagram, YouTube, and hospital websites associated with Valley Veterinary Care. I, hereby, release and discharge Valley Veterinary Care and all associated hospitals from any claims arising out of postings of photographs or videos.

  • Authorization

  • I certify that I fully understand the contents of this form and am at least 18 years of age or older in order to make decisions and receive treatment for my pet.

    I give Emergency Pet Hospital of Redlands permission to perform my pet’s initial physical examination and assessment prior to treatment and agree to pay the $90 emergency consultation fee upon check-in.

  • Date Format: MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.