Veterinary Authorization

General Info
Your Email*
Name of Pet(s)*

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Veterinary Info
Veterinary Clinic's Name*
Veterinary Clinic's Address*
Street Address Address Line 2 City State ZIP Code
Veterinary Phone*
After Hour's Emergency Clinic Info
After Hour's Emergency Clinic's Name*
After Hour's Emergency Clinic's Address*
Street Address Address Line 2 City State ZIP Code
Client Authorization
Agree 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 Signature

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Client Name*
First Last
Date*
DD slash MM slash YYYY
Additional Comments*
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General Info