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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's recommended that you place a credit card on file with your vet and inform them we will be caring for your pets.

I, (*The Pet Owner or Decision Maker) hereby give Can Do It Pet Care or Katie Bianconi LLC my express permission to transport my pet(s) listed below 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:

Veterinarians 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:

Please Check One:

I Accept

- I give permission to Can Do It Pet Care to make medical treatment decisions for my pet(s) and approve charges up to:
$ per pet (most common values are $200, $1000, or unlimited).

I Decline

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

List of Pet(s):

Pet Name and description or Breed:

If there are any additional notes or instruction, they will be indicated below.

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:

Your legal name

Your email address

Please Confirm full name and signature.

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I agree that I am and I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature

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Signed by Kate Witas
Signed On: June 22, 2021

Timestamp

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June 22, 2021 8:34 am EDT

Veterinary - Medical Care Release Form Uploaded by Kate Witas - info@cdipetcare.com IP 70.127.108.160