Pet Care Consent Form

Same-Day Urgent Care Appointments

Since 1959

Free Nutrition Counseling

Same-Day Urgent Care Appointments | Since 1959 | Free Nutrition Counseling

We, at Bethany Animal Hospital, thank you for the opportunity to care for your pet. Please fill out the form below if you would like us to authorize a different person to care for your pet when you are away.

Click here to download a printable copy or scroll below for an electronic copy.

Pet Care Consent Form

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: