Veterinary Release Form

Veterinary Release Form

The Dog House, LLC
Owner Contact Information
Pet Owner Name

First NameLast Name
Pet Owner Phone Number
Please enter a valid phone number.
Email
example@example.com
Pet Owner Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Pet Information Details
Type of Pet
Pet Name
Pet Age
Pet Insurance No
Medical Conditions
In the event of an emergency (such as illness or injury) the Pet Sitting Company will first attempt to contact you and your emergency contact. In the event that you and/or your emergency contact cannot be reached, our veterinary partners will be contacted and your pet will be treated following the attending veterinarian’s recommendation.

I understand and give the attending veterinarian permission to treat any of my pets indicated above, and I assume full responsibility for all costs and charges incurred in their treatment.
Date

MonthDayYear
Date
Pet Owner Name

First NameLast Name
Pet Owner Signature

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Veterinary Name

First NameLast Name
Veterinary Signature

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Should be Empty:

Owner Contact Information