Pet Care Emergency Authorization Form

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Pet Care Emergency Authorization Form

Please complete this form and submit in order to give authorization for an alternative caregiver to make veterinary medical decisions in your absence. If you have any questions please call us or email [email protected].

"*" indicates required fields

Owner & patient details

Owner*

Address*

Street Address Address Line 2 City Province Postal Code

Phone*

Email

Pet Name*

Species*

Breed*

Age or Birthdate*

Sex*

Colour*

Pet Name

Species

Breed

Age or Birthdate

Sex

Colour

Pet Name

Species

Breed

Age or Birthdate

Sex

Colour

Alternative Caregiver Information

Alternative Caregiver Name*

Alternative Caregiver Phone*

Alternative Caregiver Email

Consent

Expiration date of this form*

This would be the date after which the alternative caregiver is no longer authorized to make veterinary medical decisions on your behalf.

Owner's Consent

Signature*

Pet Care Emergency Authorization Form

Owner & patient details

Alternative Caregiver Information

Consent

Owner's Consent

Weste Animal Hospital

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Emergency Line

Pet Care Emergency Authorization Form

Need a Prescription Refill?

Owner & patient details

Alternative Caregiver Information

Consent

Owner's Consent