Veterinarian Release Form printable pdf download

Veterinarian Release

Form

781-9DOG (9364)

LLC

Should unfortunate circumstances arise and my pet(s) need emergency or non-emergency medical care due

to illness or injury, I request Tall Tails Pet Sitting Services take my pets to:

Hospital__________________________________________ Phone_____________________________

Dr. Name___________________________________________ Address ____________________________

City____________________________

Zip ______________________

I give permission to Tall Tails Pet Sitting Services to approve treatment in the amount of $___________or

less. I will assume responsibility upon my return for payment and/or reimbursement of medical services for

my pet(s).

If the requested veterinarian is not available, another veterinarian in their clinic is acceptable. If emergency

care is needed after regular veterinarian office hours, my pet(s) may be taken to the nearest emergency

veterinarian hospital. I understand that Tall Tails Pet Sitting Services is not liable for the loss of any pet

beyond the monetary replacement value of the pet.

Signing this form gives Tall Tails permission at the present date_____________ as well as future

veterinarian emergency and non-emergency care without additional authorization each time Tall Tails cares

for my pet(s). It is my responsibility to inform Tall Tails Pet Sitting if I change veterinarian.

Pet’s Name____________________Type___________________ Age_____ Meds _________________

Care and Feeding:______________________________________________________________________

______________________________________________________________________________________

_______________________________________________________________________________

Owner’s _________________________________Address______________________________________

City__________________________ LA

Zip___________________Phone_______________________

Emergency ________________________ Cell: _____________________Cell: ____________________

Signature____________________________________________Date_____________________________

Veterinarian Release Form