Veterinary Release Form

Accidents happen to the best of us. We want to ensure that no matter what happens your pet is taken care of. In the event of a medical emergency I will attempt to contact you by phone. If I cannot contact you by phone, this form will allow me to provide care for your pet.

Name

First Name

Last Name

Pets Name

First Name

Last Name

Phone

By entering your phone number you consent to receiving calls/texts from Lone Peak Pet Services and/or the Vet Clinic We never sell or share your personal information

(###)

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Breed

Pets Age

Primary Vet Clinic

Primary Vet Clinic Address

Primary Vet Clinic Phone Number

(###)

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I give permission to Lone Peak Pet Services to approve treatment up to

No Limit

$250

$500

$1000

Other

Other amount

I hereby give Lone Peak Pet Services my express permission to take my pet/s to the above-mentioned veterinarian (or to the closest open facility in case of emergency). I give permission for the veterinarian to administer any care or medications necessary. I will assume full responsibility for the payment for any and all veterinary services provided

I agree

Date

YYYY