Permission of Care Form

Permission Of Care

* Indicates required field

I will be out of town/out of the country and give the following person permission to bring my pet(s) in for veterinary services while I am away: Owner's Name *

Caregiver's Name *

Caregiver's Phone Number *

Please list the dates your pet(s) will be under the care of the caregiver *

Please list all of the names of the pets that the caregiver is authorized to seek care for: *

Do you authorize the Veterinarian to provide care and do what is needed for your pet(s) if you are unable to be contacted? *

Do you authorize the caregiver to make decisions on your behalf if you are unable to be contacted? *

Please choose from the following prompts the level of care we are authorized to perform *

By typing your name below, you are electronically signing this agreement. *

date *

Owner's Phone Number *

Owner's Email *

please list the name and phone number of a secondary contact *

Is there anything else you'd like us to know? *

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Permission Of Care

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