Veterinary Authorization
Personal Information
Your Email
*
Name
*
First Name
Last Name
Name of pet(s)
Veterinary Information
Vet Clinic Name
*
Vet Clinic Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Client Authorization
Any of the pets listed above that become ill or are injured should be taken to the veterinarian listed above by the sitter of Pet Comfort & Clean Spaces. This is permission for the pet sitter to approve treatment up to the following amount (please input in the box below). My full responsibility will be to pay or reimburse Pet Comfort & Clean Spaces for any veterinary services up to the above stated amount, upon my return. Pet Comfort & Clean Spaces may take my pet(s) to another veterinarian if the veterinary office mentioned above is not available. I understand that the pet sitter is not liable for the outcome of veterinary treatment or for the loss of my pet(s). This agreement is valid starting on the date below whenever Pet Comfort & Clean Spaces is hired to care for my pet(s).
Treatment Amount Approval
*
Enter Dollar Amount
Client Signature
*
Date
*
/
Month
/
Day
Year
Submit
Submit
Should be Empty: