Consent for Veterinary Services While Owner Away

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Consent for Veterinary Services While Owner Away

This form should be used when an owner is giving direction on medical treatment while they are away and have assigned their pet's medical care to a third party.

Date*
MM slash DD slash YYYY
Name*
First Last
Pet Name*
From Date*
MM slash DD slash YYYY
To Date*
MM slash DD slash YYYY
Cell Phone
Other Phone Number
During my absence, if my pet requires veterinary care:
- I wish to be contacted PRIOR TO any medical procedures or diagnostics. Specifically, I want the veterinarian on duty to obtain my consent, verbal or written, prior to providing veterinary care.
- My pet will be cared for by (named below) and I provide consent during my absence that they have the authority to agree to any necessary medical decision pertaining to my pet (named above) under the guidance of Amherst Veterinary Hospital.
- I will cover all veterinary costs associated with my pet during my absence. Costs can be charged to the following credit card.
- I have made arrangements with my pet sitter and they will pay for all veterinary costs incurred directly.
Credit Card Information
- Please contact Amherst Veterinary Hospital to provide your payment information at 604-221-7771. This is the most secure method of ensuring your financial information is protected.
Pet Sitter Name*
First Last
Pet Sitter Contact Number*
Consent*
- By selection of this field and submission of this form I provide consent for the above instructions to Amherst Veterinary Hospital for the care of my pet while I am away.

Consent for Veterinary Services While Owner Away

Consent for Veterinary Services While Owner Away

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Tuesday	8:00am – 8:00pm
Wednesday	8:00am – 8:00pm
Thursday	8:00am – 8:00pm
Friday	8:00am – 6:00pm
Saturday	8:30am – 5:00pm
Sunday	Closed