Pet(s) Name *

Name of Authorized Individual *

Authorized Person’s Phone number *

I, *

give permission for to care for my pet in my absence. He/ she has my permission to transport them to and from your clinic or request “on site” treatment from your office as is deemed necessary.

I authorize Kind Animal Care and their agents to treat and/ or make any decisions in regards to my pet(s) in a matter that is best suited to my pet’s condition and I state that we will be fully responsible for all fees and charges and will pay for all charges incurred on my pet’s behalf upon the day of service. I further authorize you to give out any information about my pet to *

I can be reached, if necessary, at *

Client Name *

Signature *

Clear Signature

Date *

We can’t wait to meet you!

Permission to Treat Veterinarian Authorization Form

Permission to Treat Veterinarian Authorization Form

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