Adored Pet Services: Veterinary Release Form

Pet(s) Name(s)

Breed(s)

Pet(s) Birth Date(s)

Veterinarian Name:

First NameLast Name

Name of Veterinary Clinic

Veterinarian Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Veterinarian Phone Number:

Area CodePhone Number

Know Medical Conditions:

During my absence, Adored Pet Services will be caring for my pet(s). In the event of an emergency, I authorize you (veterinarian) to administer medical treatment and will be responsible for payment to you (veterinarian) upon my return.

I give Adored Pet Services permission to transport my pet(s) to the above veterinarian and authorize treatment in the event of an emergency or sickness.

If this veterinarian is not available, I authorize Adored Pet Services to transport my pet(s) to a veterinarian of choice and authorize treatment. If emergency care is needed after regular office hours, my pet(s) may be taken to the nearest Veterinarian Emergency Clinic/Hospital.

I agree to authorize veterinarian to euthanize my pet in EXTREME circumstances after all reasonable attempts have been made to reach me or my emergency contact.

I agree that Adored Pet Services is released from all liability related to transportation to and from veterinarian and treatment for sickness or emergency.

This release will remain valid for all current and future visits unless a new release is signed.

I give permission to Adored Pet Services to approve treatment up to (input maximum dollar amount or “no limit”).

Client is responsible for all costs including, but not limited to, vet fees, extra visit fees and transportation fees.

In the event of my pets death, I would like them to be:

CrematedKept at VetOther

Payment Information on file for Veterinarian:

I will leave credit card on fileVets office will bill meOther

Signature