Absent Owner Treatment Consent Form

A form veterinary clinics use to get advance authorization from pet owners to treat their animals while the owner is away.

Use this template

Owner name

First Name

Last Name

Phone number

Owner email

Departure date and time

Return date and time

Authorized agent name

Authorized agent address

Street Address

City

State / Province

ZIP / Postal Code

Select one option regarding your pet's veterinary care

I authorize any necessary treatment I only authorize emergency treatment I must be contacted before any treatment

Select one option regarding the financial cost of treatments

I authorize expenses with no limit I authorize expenses up to a maximum amount I must be contacted before any expense is authorized

Text

Signature

Sign here

Related templates