Nocturne Pet Care Consent Form:

Nocturne Pet Care Consent Form:

Overnight and Extended Care Veterinary Consent and Emergency Contact Form:
Owner Information
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
While I am out of town, I prefer to be contacted by
Pet Information

Tell me about your animal(s)
Pet 1: name, age, species, and breed*
Pet 2: name, age, species, and breed
Pet 3: name, age, species, and breed
Pet 4: name, age, species, and breed
Pet 5: name, age, species, and breed
Medical/Emergency Care Needs
Does your dog have any medical problems (seizures, painful conditions, etc.)?*

YesNo
If yes, please list them and explain any accommodations or support I should provide them.
Is your pet on any medications that I will need to administer?*

YesNo
If yes, please provide the medication(s), dose, and when and how to administer
If your pet needs to be crated or confined, how do they react?*
Emergency Contacts and Vet Information
What is the best phone number to reach you at, in case of an emergency?*
Please enter a valid phone number.
What is the name of your Primary Vet or Vet Clinic?*
Primary Veterinarian's Phone Number*
Please enter a valid phone number.
Primary Veterinarian's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Does your primary veterinarian have 24h emergency hours?*

YesNo
If NO, please list the name, and number of closest 24-hour Emergency vet
Secondary Contact: In the event that you cannot be reached, Is there someone I can contact for additional support?*

First NameLast Name
Secondary Contact Phone Number*
Please enter a valid phone number.
Relationship to you*
Policies Acknowledgments
1. Liability Release

I, the undersigned Pet Parent, understand and agree that Nocturne Pet Care Co. (hereafter “the Care Provider”) will care for my pet(s) to the best of their ability. I acknowledge that animals can be unpredictable and that certain situations or incidents may occur despite reasonable precautions.

I agree to release the Care Provider from liability for:

Illness, injury, or death resulting from pre-existing conditions, age-related conditions, or unforeseen and unpreventable circumstances.

Injuries or behavioral incidents that occur despite reasonable safety measures.

Loss, damage, or injury caused by my pet(s) to themselves, the Care Provider, third parties, or property, except in cases of proven negligence.

Situations arising from incomplete or inaccurate information provided by me regarding my pet’s health, behavior, or needs.

I understand the Care Provider will always act in good faith and prioritize the wellbeing of my pet(s).

2. Emergency Medical Authorization

If an emergency arises and I or any listed emergency contact cannot be reached, I authorize the Care Provider to:

Transport my pet(s) to the nearest available veterinary clinic;

Give permission to the veterinarian to administer treatment deemed necessary for my pet’s health and safety;

Make decisions on my behalf to ensure urgent, appropriate care.

I agree to assume full financial responsibility for all veterinary costs and emergency services incurred while my pet is under the Care Provider’s care.

By checking the box below, I agree to and accept the above policies.
I agree and acknowledge
Signature*

Powered by Jotform SignClear
Date

MonthDayYear
Date
Should be Empty:

Nocturne Pet Care Consent Form:

Owner Information

Pet Information

Medical/Emergency Care Needs

Emergency Contacts and Vet Information

Policies Acknowledgments