VETERINARY RELEASE FORM
This form will be retained on file and will be used to authorize veterinary treatment in the event that your pet(s) require treatment during your absence, and we are unable to contact you at the time. Should you change veterinarians please notify Twin Ports Pet Sitters before service dates.
Full Name:
Spouse's / Partner's Name:
Home Address:
Primary Phone Number:
Veterinary Information Your pet's health and wellbeing are paramount. Usuallythere is no need for veterinary care while you are away. But what if your pet requires medical attention while you're away? We need your authorization in order to get your pet the medical attention it may need in case of an emergency. **Please take the time to notify your vet that you will be using our services. We encourage you talk to your veterinarian and ask about his/her policies in regard to caring for your animals while you're away. You should also check with the pet emergency centers in your area. Veterinary services are a separate contract between you and the vet's office. You are responsible for paying all veterinarian expenses and any expenses we may incur in getting your pets the medical attention they may need.**
To whom it may concern:During my absence a representative of Twin Ports Pet Sitters will be caring for my pet(s). I give Twin Ports Pet Sitters my permission to transport my pets to my veterinarian (or to an emergency clinic). In the event I cannot be reached, I authorize Twin Ports Pet Sitters to act as an agent on my behalf regarding my pets’ medical care. I accept full responsibility for charges incurred in the treatment of my pet(s), not to exceed the following amounts:
Pet #1 Name:
Pet #1 Cost Limits:
Pet #1 Care Specifics:
Pet #2 Name:
Pet #2 Cost Limits:
Pet #2 Care Specifics:
Pet #3 Name:
Pet #3 Cost Limits:
Pet #3 Care Specifics:
Veterinary Information Twin Ports Pet Sitters reserves the right to utilize the services of any available veterinary clinic. If time permits, we will attempt to utilize your primary veterinary clinic. If it is not practical to do so, the following information will be helpful if the clinic we utilize requires documentation from your primary clinic.
Vet's Office:
Preferred Veterinarian:
Vet's Address:
Vet's Phone #:
Do you have pet health insurance?:
Veterinary Authorization I authorize that your pet sitter and any staff veterinarian at your vet clinic, or emergency vet clinic, have authorization to make medical decisions regarding the care of your pet(s) during your absence. Major procedures such as surgical correction of gastric dilation with volvulus, enterotomy to remove gastrointestinal foreign body, bone plating for fractures, and others are authorized as long as your primary veterinarian listed above believes there is a reasonable successful outcome. You will be contacted at the primary phone number you listed on this form if veterinary care is needed while you're away. However, if you cannot be reached, then the people mentioned shall have decision making power. You agree not to hold any party listed blow liable for competently performing treatment that do not succeed. Veterinary services are a separate contract between the pet owner and the vet clinic and the pet owner is responsible for any veterinary charges. I also agree to reimburse Kirstin Baumgarten, Twin Ports Pet Sitters and her authorized representatives for any expenses they may have incurred in getting my pet(s) the medical attention they may require. I authorize veterinary treatment for my animal(s) during my absence. I understand that Twin Ports Pet Sitters assumes no responsibility for the loss of any pet and is released from all liability related to transportation, treatment and expense. I will be responsible for any and all charges incurred during the treatment of my pets limited to the conditions of this authorization.
Signature: On file