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Veterinary instructions and release form


By Ann MacDonald

 

 

Summary: A usable form template for pet sitters to use when obtaining veterinary information and care release from clients. Includes information blanks about the pets, veterinary offices, permission to treat and responsibility for costs incurred

     

     

    VETERINARY INSTRUCTIONS AND RELEASE FORM

      

    Pet’s Name:
    Description:
    Age:
    Medical conditions/medication:

    Pet’s Name
    Description:
    Age:
    Medical conditions/medication:

    Pet’s Name:
    Description:
    Age:
    Medical conditions/medication:

     

    If any of the pets named above becomes ill or is injured, I request that petsitter take the pets to: 

    Veterinary Office Name:
    Address:
    Phone Number:

    Alternate Veterinary Office Name:
    Address:
    Phone Number:

     

    I give permission to petsitter 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 petsitter to take my pet/s to another veterinary office for treatment. I understand that petsitter 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 petsitter cares for my pets:

     

    Owner's Signature: ________________________Date: ____________________

     

    Owner's Name (please print):___________________

     

     

     

     

     

     

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