Caregiver Consent for Care

Homer Veterinary Clinic PC

326 Woodside Avenue
Homer, AK 99603

(907)235-8960

www.homervet.com

If you are heading on vacation and leaving your pet with family, friends or a boarding facility, please consider completing and submitting this form so we can meet your expectations for care should veterinary care be needed during your absence.

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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