Homer Veterinary Clinic, P.C. / Caregiver Release Form

Homer Veterinary Clinic PC

326 Woodside Avenue
Homer, AK 99603

(907)235-8960

www.homervet.com

Blurb inviting clients to submit form online or choose from the printable version or the page of printable forms.

Caregiver Release

Owners Name

Pets Name

Conditional
In the event my animal is injured or becomes ill while I am travelling or out of town, I grant consent for the Veterinarians at Homer Veterinary Clinic, PC to act in the best interest of my pet(s) and provide the necessary medical/surgical care required. I am responsible for any financial charges incurred during treatments.
I authorize the following to bring my animal(s) in for treatment

Date :
Date :
Conditional
In the event of a terminal medical condition where euthanasia is the kindest humane choice for my animal, I wish to be contacted prior to this decision being made:
Phone

e-mail

I have read the above and agree to the term and conditions. (required)
I agree
I Disagree

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