I agree that all spelling and information shown is correct.

    I am the owner, or authorized agent of the owner for this pet. I certify that I am over eighteen years of age, and hereby consent to the examination on this pet by the veterinarian on staff at this practice.

    I understand that after the initial examination of my pet, the doctor may prescribe medication, treat, hospitalize, sedate, anesthetize, and/or perform surgery on my pet. I understand that an estimate of the costs for these services will be provided to me. In signing the estimate presented to me, I am agreeing to pay the fees for the services before they are renderer for this exam and all future exams.

    Accepted payment types- Cash, Visa, Discover, Mastercard, American Express, Paypal and/or CareCredit. Checks are not accepted . Card holder must be present with valid ID in order to process payment(s). Transaction using Paypal or Carecredit subject to 5% service fee. Discounts will not be applied to transaction using Paypal or CareCredit.

    I understand Mira Loma Animal Hospital is not a 24 hour facility. I understand there is no staff on site after hours and I am responsible for picking up my pet before the facility closes. I am aware of the hours of operations. In the event my pet is hospitalized and not picked up before closing hours, I understand an additional fee of $40 will be added to my bill.

    I understand there is no guarantee in medicine, the doctor and staff will treat my pet to the best of their abilities. I will not hold Mira Loma Animal Hospital responsible for my pets recovery. I understand that some risks or complications may occur while my pet is being treated at this facility. Should unexpected life-saving emergency care be required, the practice has my permission to provide such treatment.

    Mira Loma Animal Hospital has the right to notify local animal control authorities of any neglect/cruelty cases seen fit.

    I understand that a complete copy of my medical record will be available for me and will be emailed to the email address I have provided. In the event a hard copy of the medical record is needed I understand there will be a $3.50 clerical fee per visit for the printed records.

    I am aware for appointment cancelations an additional fee of $10 will be charged to my account for any appointment cancelled with less than a 24 hour notice I authorize Mira Loma Animal Hospital to post photos and updates of my pet on social media.
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