Veterinarian Release Form printable pdf download

VETERINARIAN RELEASE FORM

AUTHORIZATION

To my regular vet: Name: _____________________________________

Address: _____________________________________

Phone: ______________________________________

In the event of illness or injury related to my pet(s). I herby authorize Paradise Doggie Day care and

it's representatives, to bring in my pet(s) for whatever medical treatment may be required. If my

regular veterinarian (named above) is not available for any reason, or the emergency should happen

after regular office hours, I further authorize Paradise Doggie Daycare to take my pet(s) to the

nearest emergency veterinarian clinic which can render assistance.

I authorize my regular and/or emergency veterinarian to render services and treatments needed.

EUTHENASIA

If euthanasia is recommended by the veterinarian:

( )

Please try to contact me first at phone numbers listed below.

( )

Proceed with euthanasia if unable to contact me

( )

Proceed with euthanasia without contacting me

( )

Do not euthanize my pet without my personal authorization

( )

Other:__________________________________________________

If Euthanasia is carried out, please arrange the following for the remains of my pet:

( )

Bring my pet home and bury

( )

Allow vet to arrange an individual cremation and return my pets ashes

( )

Allow vet to arrange an individual cremation and NOT return my pets ashes

( )

Allow vet to keep my pet- they make their own arrangements

( )

Other:__________________________________________________

COST/ PRICE LIMIT

I request a price limit for the care authorized ( ) Yes ( ) No

The price limit authorized is :_____________

I have pet insurance ( ) Yes

( ) No

Insurance policy number:____________________

Insurance contact Phone number:_________________

__________________________________________________________________

Signature of Doggie Parent

Date

Print Name:_________________________ Pet(s) Name: ______________________

Address: _____________________ Contact Phone Numbers:____________________

City/Zip:______________________

Veterinarian Release Form

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