Free Veterinary Clinic Authorization Form Template
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
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
Name:
Date:
Thank you for your submission!
We appreciate you taking the time to submit.
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