Pet Information and Veterinary Release Form

Pet Information & Veterinary Release Form

Please fill out the following information about your pet(s) and details for emergency veterinary care
Owner's Full Name*

First NameLast Name
Owner's Email Address*
example@example.com
Owner's Mobile Phone Number
Please enter a valid phone number.
Owner's Address*

Street Address

Street Address Line 2
Town/CityState / ProvincePost Code
1st Pet's Name*
Pet's Species*
Pet's Breed (if known)
Pet's Age (years)
Pet's Age (years)
Special Instructions or Medical Conditions for Pet
2nd Pet's Name (leave blank if n/a)
Pet's Species
Pet's Breed (if known)
Pet's Age (years)
Special Instructions or Medical Conditions for Pet
3rd Pet's Name (leave blank if n/a)
Pet's Species
Pet's Breed (if known)
Pet's Age (years)
Special Instructions or Medical Conditions for Pet
4th Pet's Name (leave blank if n/a)
Pet's Species
Pet's Breed (if known)
Pet's Age (years)
Special Instructions or Medical Conditions for Pet
Emergency Contact Details
Name*

First NameLast Name
Mobile Phone Number*
Please enter a UK mobile number for your emergency contact, beginning with '0'
Emergency Contact Address

Street Address

Street Address Line 2
Town/CityState / ProvincePost Code
VETERINARY RELEASE
Vet Practice Name
Veterinary Address

Street Address

Street Address Line 2
Town/CityState / ProvincePost Code
Phone Number

Area CodePhone Number
TERMS
1.      I hereby authorise the attending veterinarian to provide medical treatment to my pet(s) named above and as listed on the pet information sheet.

2.      I, as the pet(s) owner, accept full responsibility for all the expenses incurred in the treatment of any pet(s) named above.

3.      I authorise Paws and Claws Neston to transport my pet(s) to the veterinary practice or to request “on-site” treatment if deemed necessary.

4.      In the case of an emergency, I understand that Paws and Claws Neston will make every attempt to contact me, and in the event I am unavailable, then my emergency contacts.

5.      In the case of an emergency and Paws and Claws Neston being unable to contact me, or the emergency contact, I authorise Paws and Claws Neston to act on my behalf to authorise any treatment, excluding euthanasia.
Paws and Claws Neston (Pet Sitter/Dog Walker) Signature

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Owner's Signature*

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Date
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Pet Information & Veterinary Release Form

Emergency Contact Details

VETERINARY RELEASE