Owner Absent Emergency Treatment Form
Name of owner giving authorization for emergency treatment:
*
First Name
Last Name
Start Date for authorization:
*
-
Month
-
Day
Year
Date
End date for authorization:
*
-
Month
-
Day
Year
Date
Pet(s) Name:
*
Name of Pet Sitter or Authorized Agent:
*
First Name
Last Name
Phone number for Pet Sitter or Authorized Agent:
*
-
Area Code
Phone Number
I give authorization, to the above listed person, to make decisions regarding the welfare of my pet in my absence:
*
Yes
No
I authorize the Doctors of Cascade Animal Clinic to provide:
*
Any service my pet need.
Any service my pet needs up to (please list amount you would like to authorize for treatment).
Do not proceed until I can be reached. I understand that emergency treatment will be delayed.
Amount authorized
*
I can be reached at:
*
-
Area Code
Phone Number
By signing this form I authorize cascade animal clinic to provide treatment for my pet.
*
Continue
Continue
Should be Empty: