Veterinary Medical Care Release Form

VETERINARY MEDICAL CARE RELEASE FORM

In the event of a medical emergency we will attempt to contact you by phone. If we cannot reach you, this form will allow us to provide care for your pet.

Veterinary Release Form

Owner Information

Name *

Significant Other

Address *

Phone *

Pet(s) Information

Name *

Breed *

Color *

Name

Breed

Color

Name

Breed

Color

Name

Breed

Color

Primary Veterinary Information

Name of Clinic

Address

Phone Number

TO WHOM IT MAY CONCERN *

Schreiber Tails staff is authorized to transport my pet(s) to and from the veterinary clinic for treatment or to request "on-site" treatment if deemed necessary. If I cannot be reached in case of an emergency, Schreiber Tails staff shall act on my behalf to authorize any treatment excluding euthanasia.

I understand that Schreiber Tails staff will attempt to contact my primary veterinarian, but if my veterinarian is unable to see my pet within a reasonable period of time, Schreiber Tails staff will contact another available veterinarian of their choosing.

I hereby authorize the attending veterinarian to treat any of my pets as listed above and I accept full responsibility for all fees and charges incurred in the treatment of my pets.

Signature

Clear

Date