Welcome to Animal Medical Center of Redlands!

Name *

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Spouse/Partner Name

First Name Last Name

Email *

Confirmation Email example@example.com

Phone Number *

Area Code Phone Number

Alt. Phone Number

Area Code Phone Number

Address *

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Street Address Line 2

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Drivers License # *

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Employer *

company of employment

Occupation *

Spouse's Employer

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Occupation

Name of Pet Insurance

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First Name Last Name

Fees Are To Be Paid At The Time Services Are Rendered-We Do Not Offer Billing
I hereby consent and authorize the Animal Medical Center of Redlands to treat, prescribe for, or operate upon my animal(s). Should a medical emergency arise, I hereby authorize the veterinarian to perform any emergency services necessary. I assume full responsibility for all charges incurred in doing so.

You (Animal Medical Center of Redlands) are to use all reasonable precautions against injury, escape, or destruction of my pet(s). You will not be held liable or responsible in any matter, or circumstances, on account of the care, treatment or safekeeping of my pet(s). It is understood that I assume all risks. Financial responsibility for services rendered is due at the time of discharge.

I also understand that Animal Medical Center of Redlands is not staffed 24 hours a day and after hour treatment of patients is at the discretion of the veterinarian.

Unless directed otherwise, Animal Medical Center of Redlands, its representatives and employees reserves the right to take photographs of clients and their pets, and to copyright, use and publish the same print and/or electronically for the purposes of publicity, illustration, advertising and Web content.

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Welcome to Animal Medical Center of Redlands!

Pet Information