Veterinary Clinic Authorization Form

Veterinary Clinic Authorization Form

Please complete this form to authorize medical treatments, procedures, or services for your pet at our clinic.

Pet Owner’s Information

Name

    Phone number

      Email

        Pet’s Information

        Pet’s Name

          Species

            Breed

              Age

                Weight

                  Authorization

                  Please check the services you authorize.

                    • Routine Examination

                    • Vaccination(s)

                    • Medical Procedure

                    • Emergency Care

                    Emergency Contact

                    Name

                      Phone number

                        Acknowledgment and Consent

                        I, the undersigned, hereby authorize [Your Company Name] to perform the selected treatments or services on my pet. I understand the risks involved and agree to cover all associated costs.

                        Name:

                        Date:

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