Pet Sitter Authorization Form
Michael Foss, DVM - Rachel Foss, DVM - Zach Shoufler, DVM - Savannah Gucwa, DVM
Pet Owner Information:
*
Name
Address
*
Street Address
Street Address Line 2
City
State / Province (2 letters)
Postal / Zip Code
Phone number where I can be reached
*
-
Area Code
Phone Number
Date of absence
*
-
Month
-
Day
Year
Date
Pet Sitter Information:
Name
*
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Pets Name(s):
*
I, the owner of the above-named pet, authorize the above pet sitter to seek medical care for my pet in the event that my pet should become ill and need medical treatment. This agreement shall be effective:
*
Specific Dates
Ongoing, until I give further notice
From:
Date
*
To
Date
*
Should an injury or illness occur to my pet(s) that requires veterinary care during my absence, I authorize the pet sitter to act as my agent in procuring essential veterinary medical care. I agree to pay the fees for such professional veterinary services using the following payment method:
*
Place Debit/ Credit Card on file
Please contact me for payment
Do not exceed $____________, without contacting me.
*
USD Amount
In the event the attending veterinarian determines that my pet is suffering and/or is incurably injured,
*
Give my consent for euthanasia
Do not give my consent for euthanasia
If my pet should die or is euthanized, I request that the body, and I agree to pay the fees for such services.
*
Be retained until I return
Be privately cremated
Be communally cremated
Home Burial
Signature
*
Clear
Date Signed
*
-
Month
-
Day
Year
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Submit
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