Veterinarian Release Form - Duffy'S Bed And Biscuit printable pdf download

Veterinarian Release Form

Veterinarian Information:

Hospital Name: ______________________________________ Veterinarian Name: ______________________________________

Address: ______________________________________ Phone: ______________________________________

To the Veterinarian Hospital:

Duffy’s Bed and Biscuit has been contracted to perform boarding services for my dog(s) and has my permission to

place them in your care in case of an emergency. Duffy’s Bed and Biscuit will attempt to contact me as soon as

medical care is deemed necessary. However, in the event I cannot be reached immediately, I authorize you to treat

my dog(s) and I will be responsible for payment of any fees as stated below. Please file a copy of this form with my

records.

Dog Owner Name (Please Print):

Address:

______________

Phone: ______________________________________ Name of Dog: ______________________________________

Breed: ______________________________________

1. If above named veterinarian is not available, I agree that another vet in his/her practice may care for my dog(s). If

neither of these veterinarians are available, I give permission for Duffy’s Bed and Biscuit to take my dog(s) to the

nearest animal hospital or emergency clinic.

2. I give permission for Duffy’s Bed and Biscuit to approve treatment up to $____________. ( _____ initial)

IMPORTANT: An amount must be specified above or we may not be able to obtain the proper care for your dog.

3. I understand that Duffy’s Bed and Biscuit assumes no responsibility for the loss of any dog and is released from all

liability related to transportation, treatment and expense.

4. Other conditions, if any:

________

_______________

_______

My dog(s) has/have the following health issues:

_______________________________________________________________

__________________________________________________________________________________________________________

_________________________________________________________________________________________________________________

___________________________________________________________________

____________________

_____

This consent for treatment has no expiration date unless otherwise noted.

___________________________________________________

_______________

Client Signature

Date

1 Duffy’s Bed and Biscuit – Veterinarian Release Form (Rev A) 2012

Veterinarian Release Form - Duffy'S Bed And Biscuit