Please provide the following information. In addition to the online form you must also call us to notify you are here.

1. Pet Information
Who is your pet's regular veterinarian?
Coronavirus Safety

If someone in your pet's environment has potentially been exposed to COVID-19 we will still see your pet, but we need to know so that we can wear additional PPE equipment and take additional precautions. Pets cannot be afflicted with the virus, but they can carry COVID-19 on their body. If anyone in this pet's household has had a fever in the past 14 days, or been exposed to someone suspected of having (or testing positive for) COVID-19, you must answer 'Yes' to the following question so that we can keep everyone safe:

2. Primary Contact Information
3. Secondary Contact Information
4. Authorization & Consent
By clicking 'Agree' and submitting this information online, I signify the following:

I am the owner of the above listed pet, or I am authorized by the owner to act on their behalf. I give permission to proceed with an initial pet examination to determine appropriate treatment.

I understand and agree that I am liable for any and all fees and costs associated with the initial pet examination and additional approved treatment(s) received by this pet (if acting on behalf of the owner, both the owner and I are personally liable, jointly and severally). I agree to pay such fees and costs when requested to do so. I understand that all payments for treatment(s) received by the pet must be paid prior to the pet's release, and if payment is not made in full when the pet is scheduled for release, there will be additional fees and costs associated with boarding and otherwise caring for the pet until the pet is released.

I understand that while Animal Emergency Center (AEC) will strive to provide this pet with the best possible treatment(s), AEC cannot guarantee any results of the treatment, and that payment is not conditioned on receiving any particular results.

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