Veterinary Release Form printable pdf download

Veterinary Release Form

Owner's Full Name(s): __________________________________

Pet(s) Names: _____________________

Owner’s Address: ______________________________________

_____________________

_____________________________________

Email:_______________________________________________

Telephone Number: ____________________________________

Cell Phone Number: ____________________________________

Text? Y or N

Preferred veterinarian/clinic: _____________________________

Phone: __________________________

Veterinarian/clinic address: ______________________________

TO WHOM IT MAY CONCERN

I hereby authorize the attending veterinarian to treat any of my pets as listed on the Pet Information sheet and I accept

full responsibility for all fees and charges incurred in the treatment of any of my pets.

Mid-Day Play/Pet Sitter is authorized to transport my pet(s) to and from the veterinary clinic for treatment or to request

"on-site" treatment if deemed necessary. If I cannot be reached in case of an emergency, the Sitter shall act on my behalf

to authorize any treatment excluding euthanasia.

Pet Sitter's Full Names: __________________________________

Owner's Signature: _____________________________________

Date: ________________________________________________

Veterinary Release Form