Pet Care Consent Form

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We, at Bethany Animal Hospital, thank you for the opportunity to care for your pet. Please fill out the form that you need to complete.

Click here to download a printable copy.

NOTE: You may forgo the signature section included on the forms. However, a signature may be needed at the time of the appointment.

Call today to schedule an appointment.

Free Text

To Whom It May Concern:

Owner Last Name

owner of

authorize

Free Text

to make veterinary medical decisions, for the animal described below in the event that I cannot be reached or am not present. I accept financial responsibility for the emergency care of the animal(s).

Owner’s name:

Owner’s contact information in case of emergency (provide all forms of contact):

Other contacts (travel companions, etc. – name and contact information):

Dates of travel or expiration date of this form:

Animal’s name:

Authorized agent:

Relationship to pet owner:

Contact information for authorized agent:

I authorize emergency veterinary care costs up to $

Owner’s name:

Owner’s signature:

Date:

Payment Options:

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Pet Care Consent Form