Veterinary Release Form

Emergency Veterinary Release
Owner Contact Information
Pet Owner Name

First NameLast Name
Pet Owner Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Pet Owner Address

Street Address

Street Address Line 2

CityProvince

Postal Code
Pet Information Details
Pet Name
Pet Age
Rabies Vaccine Expiration

MonthDayYear
Date
Pet Insurance (if any)
Pre-Existing Medical Conditions
I thus give the attending veterinarian permission to treat any of my pets indicated above in the event I cannot be contacted. I assume full responsibility for all costs and charges incurred by any decision made my Fergus Canada.
Date

MonthDayYear
Date
Pet Owner Name

First NameLast Name
Pet Owner Signature
Should be Empty:

Emergency Veterinary Release