Ann M. Jones
PET SITTING SERVICES
VETERINARY CARE AUTHORIZATION FORM
Pet Owner Name:
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone:
Alternate Phone:
Email:
example@example.com
Pet's Name: (enter pet's name)
Species:
Breed:
Color/Description:
Veterinary Clinic Name:
Veterinarian:
Clinic Phone:
I, the undersigned owner of the above-named pet, authorize Ann's Pet Sitting and its representative, Ann Jones, to seek veterinary care in the event of illness, injury, or emergency while my pet is in their care.
I authorize the attending veterinarian to provide necessary medical treatment, including examinations, diagnostics, medications, anesthesia, surgery, and hospitalization as deemed appropriate for my pet's health and safety.
I understand that Ann's Pet Sitting will make every reasonable effort to contact me before seeking treatment. However, if I cannot be reached in a timely manner, I authorize Ann's Pet Sitting to make decisions regarding my pet's care in consultation with the attending veterinarian.
I accept full financial responsibility for all veterinary expenses incurred on behalf of my pet.
Emergency Contact (if owner cannot be reached):
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Phone:
Owner Signature:
Printed Name:
Date:
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Month
-
Day
Year
Date
Sitter Signature:
Date:
-
Month
-
Day
Year
Date
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Should be Empty: