Veterinary Authorization General InfoYour Email* Name of Pet(s)* Hit Plus on the right to add more pets.Veterinary InfoVeterinary Clinic's Name* Veterinary Clinic's Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Veterinary Phone*After Hour's Emergency Clinic InfoAfter Hour's Emergency Clinic's Name* After Hour's Emergency Clinic's Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Client AuthorizationAgree to below Statement?* Check to Agree If any of the pets named above becomes ill or is injured, I request that Gentle Hands Pet Sitting to take the pets to a veterinarian listed above. I give permission for pet sitter to approve treatment to the amount below (please input in below field) I will assume full responsibility upon my return for payment and / or reimbursement for veterinary services up to the above stated amount. If neither of the veterinary offices named above is available, I authorize Gentle Hands Pet Sitting to take my pet(s) to another veterinarian for treatment. I understand that the pet sitter cannot be held responsible for the results of the veterinary treatment or the loss of my pet(s). This agreement is valid starting on the date below whenever Gentle Hands Pet Sitting cares for my pets.Treatment Amount Approval*Client SignatureSign with your mouse or finger if on phone / tablet.Client Name* First Last Date* DD slash MM slash YYYY Additional Comments*