Veterinary Release Form

Owner's Full Names:*

Address:*

Contact Telephone:

Mobile:*

Email Address:*

Emergency Contact Name:*

Emergency Contact Telephone:*

Pet 1

Name:*

Age:*

Description:*

Medical Conditions/Medication:

Pet 2

Name:

Age:

Description:

Medical Conditions/Medication:

Pet 3

Name:

Age:

Description:

Medical Conditions/Medication:

Pet 4

Name:

Description:

Age:

Medical Conditions/Medication:

If any of the pets named above becomes ill or is injured, I request Happy Waggers and Sleepy Whiskers to take the pets to:

Veterinary Office Name:*

Address:*

Postcode:*

Contact Telephone:*

Alternate Veterinary Office Name:

Address:

Postcode:

Contact Telephone:

If the chosen Veterinary Offices are unavailable or far away in the case of an emergency, I give Happy Waggers and Sleepy Whiskers permission to choose an appropriate alternative.

If your pet/pets are insured:

Pet Insurance Number:

Policy Company

TO WHOM IT MAY CONCERN

I hereby authorize the attending veterinarian to treat any of my pets as listed above and I accept full responsibility for all fees and charges incurred in the treatment of any of my pets. The Dog Walker/Pet Sitter is authorised to transport my pet(s) to and from the veterinary clinic for treatment or to request "on-site" treatment if deemed necessary. If I cannot be reached in the case of an emergency, the Dog Walker/Pet Sitter shall act on my behalf to authorize any treatment excluding euthanasia.

I give permission to approve treatment up to £*

I will assume full responsibility upon my return for payment and/or reimbursement for veterinary services rendered up to the above stated amount. Owner's Signature:* [signature* dogownersignature 400x200 id:bord]

Date:*