Caregiver Consent form

SANTA FE
ANIMAL HOSPITAL, PC
CAREGIVER CONSENT
To the Staff of Santa Fe Animal Hospital:

I am giving my permission for:
CAREGIVER'S NAME
CAREGIVER'S PHONE NUMBER
to make any decision regarding the medical care of my pet(s) during my absence.

I, hereby, authorize the staff of the Santa Fe Animal Hospital to treat my pet(s) by providing the necessary care to ensure their quality of life. This includes but is not limited to: examinations, x-rays, surgery, preventative treatments, lab work and the possibility of euthanasia.

I agree to pay for any and all charges occured within 10 days of service.
Beginning Date

MonthDayYear
Date
Ending Date

MonthDayYear
Date
Owner Name (Please Print)
Out of town phone number?
Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

ANIMAL HOSPITAL, PC