Veterinary Release Form

    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.

    Date:*