Code of VA Amendment & VA Veterinary Disclosure Form

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Code of Virginia Amendment

§54.1-3806-1 Disclosure forms required.

Any animal medical care facility in the Commonwealth, excluding those facilities dealing with
livestock as defined in §3.1-796.66, which does not provide continuous medical care for all animals
left in its charge shall, before taking charge of an animal, provide the client or agent thereof with a
disclosure form which specifies the hours and days when continuous medical care is not available by
the facility. Such form shall be separate and apart from any other form or information provided by
the facility. Except in emergency situations when time or circumstances do notpermit, such facilities
may take charge of an animal only afterthe client or agent thereof has signed the disclosure form and
returned it to the facility. Only one signed form per client shall be required, and the form shall be
kept on file by the facility.

Virgina Veterinary Disclosure Form

Please read carefully before signing.

Kiln Creek Animal Care is continuously staffed bymedical, kennel, and business personnel during the
following hours:

Monday – Friday: 7:30 AM to 6:00 PM

Saturday: 8:00 AM to 12:00 PM

Continuousstaffing isnot provided at other hours or in major holidays; however, medical and kennel
staff are present on a non-continuous basis each day to provide the proper care for your pet. Patients
requiring continuous monitoring and medical treatment (i.e. intensive care) attimes of noncontinuousstaffing by this facility can be transferred by the owners or their agent to the Animal
Emergency Center where after hours staffing is provided. Any expenses incurred at the Animal
Emergency Center will be the responsibility of the owner and will be payable to the Animal
Emergency Center.

I have read this form, and I am aware of the staffing hours.

MM slash DD slash YYYY

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