Out of Town Authorization Form

In case I cannot be contacted in an emergency:

I hereby give authorization to the above contact/caregiver to make decisions regarding medical treatment for my pet on my behalf up to and including euthanasia if required *

I hereby give authorization to the above contact/caregiver to make decisions regarding medical treatment for my pet on my behalf except for euthanasia *

I am willing to spend up to the amount stated below in treatments on my pet, without further authorization from myself, or my emergency contact/caregiver.

Please explain to what extent you will allow your animal to be treated and if you are willing to have surgery performed if deemed necessary by the veterinarian in charge.

In the event of an emergency, I hereby give the Trenant Park Pet Clinic authorization, and release any of its associates of any liability to euthanize my animal if the animal is suffering and it is the only humane solution to end any prolonged suffering.

 

I also agree that any charges incurred from treatment at the Trenant Park Pet Clinic will be paid upon my return.

 
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This form will stay on permanent record or until further notified by the owner.

 

TRENANT PARK PET CLINIC RESERVES THE RIGHT TO TREAT ANY PET FOR FLEAS IF IT IS DETERMINED THAT HE/SHE IS CARRYING THEM
 

 

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