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.

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Owner name

Nombre

Apellido

Phone number

Owner email

Departure date and time

Return date and time

Authorized agent name

Authorized agent address

Dirección

Ciudad

Estado / Provincia

Código postal

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

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