Can Do It Pet Care

Medical Release Form


Veterinary Medical Care Release Form

In the event of a medical emergency where Can Do It Pet Care can not contact you to authorize care immediately and directly, Can Do It Pet Care will use this form to obtain care.  It is recommended that you place a credit card on file with your vet and tell them we will be caring for your pets. ***Please PRINT clearly in blue or black ink***

I,  (pet owner) hereby give Can Do It Pet Care my express permission to transport any of my pet(s) for care to the below mentioned veterinarian (or to closest open facility if the Primary Vet office is not available).

Primary Veterinarians Information

Name of Vet Hospital or Clinic:  Phone number:

I understand that Can Do It Pet Care will try to contact me as soon as possible in the event of a medical emergency. If Can Do It Pet Care cannot contact me, I give permission to Can Do It Pet Care to make medical treatment decisions and approve charges up to $ per pet (most common values are $200, $1000, or unlimited)

 

I do not want my pet to receive Veterinary Medical Care unless I authorize with vet clinic.  (Initial)

I will assume full responsibility for the payment and/or reimbursement for any and all veterinary services rendered, including but not limited to diagnosis, treatment, grooming, medical supplies, and boarding.  I also agree to be responsible for all fees assessed by Can Do It Pet Care for emergency transportation, care, supervision, and veterinary services.

 

List of Pet(s):

Name/Description or Breed:

 

Name/Description or Breed:

 

If anything changes from what is listed above I will inform Can Do It Pet Care before the next service is scheduled to begin.

This agreement is valid from the date below and grants permission for future veterinary care without the need for additional authorization each time Can Do It Pet Care cares for one or more of my pets. In signing this contract, I agree that I have the authority to make health, medical and financial decisions regarding the animals that will be scheduled to receive service.

Leave this empty:

Can Do It Pet Care https://www.cdipetcare.com
Signature Certificate
Document name: Medical Release Form
Unique Document ID: c9cafcab726c06c6de58829d3f810a5aa17a37d3
Timestamp Audit
September 20, 2017 3:32 pm EDTMedical Release Form Uploaded by kate witas Witas - [email protected] IP 173.170.201.213