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Consent for Treatment

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Consent Form

Fill out the form below, and a member of our team will be in touch with you if we have any questions! Please Note: Any fields marked with * are required.

I hereby authorize the following people to present my pet(s) for treatment in my absence should an injury or illness occur to my pet(s) that requires veterinary care. I will provide the following people with a method of payment (Cash, Check, or Credit Card (Visa, Mastercard, Discover) to pay the bill at the time of service. *

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This includes any medical treatments, anesthesia consents, or surgical procedures, and to sign for charges. With fees, the total cost should not exceed ($):

I authorize any veterinarian to provide my pet with veterinary care and essential medical service. Do you authorize intensive medical efforts for your pet? *

In the event the attending veterinarian determines that my pet is suffering and/or is incurably injured, do you give your consent for euthanasia? Please understand that if your pet’s health is this critical, we will try everything in our power to get in contact with you before any decisions are made. *

I will be able to be reached at the following phone number: *

Pet Caretaker #1 *

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Phone *

Pet Caretaker #2

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Last

Phone

Email *

Date *

Date of Departure

Return Date

Consent for Treatment

Consent Form

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