Vet Information

 

Owner Name: ________________________________

Owner Number: ______________________________

 

Pet Information Veterinarian Information Type of Animal: _____________________________

Veterinarian: ____________________________

Animal’s Name: _____________________________ Address: _______________________________

Birth Date: _________________________________ Phone: ________________________________

Known medical conditions: _____________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________

During my absence, The Unbound Hound will be caring for my pet(s). In the event of an emergency, I authorize you (veterinarian) to administer medical treatment and will be responsible for payment to you (veterinarian) upon my return. I, _________________________________, give The Unbound Hound permission to transport my pet(s) to the above veterinarian and, if I cannot be promptly contacted to do so myself, to authorize treatment in the event of an emergency or sickness. If this veterinarian is not available, I authorize The Unbound Hound to transport my pet(s) to a veterinarian as stated in the Client Playbook and, if I cannot be promptly contacted to do so myself, to authorize treatment. If emergency care is needed after regular office hours, my pet(s) may be taken to the nearest Veterinarian Emergency Clinic/Hospital. I agree that The Unbound Hound is released from all liability related to transportation to and from veterinarian and treatment for sickness or emergency. This release will remain valid for all current and future visits unless a new release is signed.

 

_____________________ Client’s Signature       ________________ Date

______________________ Cell Phone