This form is to give authorization to a pet sitter or any other person you trust to make medical decisions on your behalf for your pet(s). This form will be valid only through the dates you have listed for the times you will be unavailable. Another form will be required the next time you plan to be away.
Expected Dates of Absence
I, the owner of the above-named pet(s), request that the caretaker I have indicated feed, excercise, groom and provide routine care for my pet(s) while I am away from home per my oral or written instructions. Should an injury or illness occur to my pet(s) that requires veterinary care during my absence, I authorize the pet sitter to act as my agent in procuring veterinary care, with fees not to exceed that which I indicate. I agree to pay the fees for such professional veterinary services as soon as possible after I return and, in the absence of gross negligence, will not hold the pet sitter liable for injuries or illnesses suffered by my pet(s) or any fees for veterinary services incurred on their behalf.
In the event of an emergency...
I can be reached at the following location/phone number:
Consent and Authorization for Medical Treatment
I hereby authorize the pet sitter named above to seek veterinary services from the facility listed below in order to provide essential medial and/or surgical services without my express written or verbal consent.
Old Town Veterinary Hospital
701 E University Ave.
Georgetown, TX 78626
"Intensive medical care" includes but is not limited to any medical means the doctor deems necessary to keep the above named animal(s) alive, such as cardiopulmonary resuscitation, intravenous fluids, complete blood count and chemistry panel (blood work) and medications. I also understand that by administering intensive medical care it does not guarantee the survival of my pet, but it the best effort that can be made.
In the event that the attending veterinarian determines that my pet is suffering and/or is incurably injured...
***By requesting cremation, I agree to pay the fees for such services upon my return.