Vet Instructions & Release Form
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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:
Description:
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:
Phone Number:
Veterinary Instructions & Release Form
