RESCUE RECHECK AUTHORIZATION

RESCUE NURSE/RECHECK AUTH - Filled out by rescue, not foster
This Pet is:
Adopted Pet – Who is responsible for paying?
This pet is coming in for:*
Rescue *
If this is scheduled to be seen by a nurse, do not authorize any services or medications that require a doctor’s exam.
Contact for medical approvals*
Foster Name & Number*
Pet's Name*
EMAIL FOR INVOICE/MEDICAL RECORDS? YOU WILL ALSO GET A COPY OF THIS AUTHORIZATION:
example@example.com
List what you are authorizing for this appointment::
If this is scheduled to be seen by a nurse, do not authorize any services or medications that require a doctor’s exam.
Should be Empty:

RESCUE NURSE/RECHECK AUTH - Filled out by rescue, not foster