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Household Vet Instructions & Release Form Example
SmartDraw includes Household Form examples like this Household Vet Instructions & Release Form template that you can easily edit and customize in minutes.
Text in this example:
I give permission to to approve treatment up to $ . I will assume full responsibility upon my return for payment and/or reimbursement for veterinary services rendered up to the above stated amount. If neither of the veterinary offices named above is available, I authorize to take my pet/s to another veterinary office for treatment. I understand that cannot be held responsible for the results of the veterinary treatment or the loss of my pet. This agreement is valid starting on the date below whenever cares for my pets. Owner's Signature: Date: Owner's Name (please print): Pet's Name: Age: Pet's Name: Age: Description: Description: Medical conditions/medication: Medical conditions/medication: Pet's Name: Age: Pet's Name: Age: Description: Description: Medical conditions/medication: Medical conditions/medication: If any of the pets named above becomes ill or is injured, I request that take the pets to: Veterinary Office Name: Alternate Veterinary Office Name: Address: Address: Phone Number: Phone Number: Veterinary Instructions & Release Form