Veterinary Release Form

In the event of an emergency, I (Megan Stafford - Owner of Cookie’s Canine Comforts) will make reasonable attempt to try and get hold of you. If I cannot get in contact with you, this form will allow me to ensure your pet(s) receive appropriate medical attention. Please complete this form in full and submit.

Thank you!

Cookie’s Canine Comforts

First name

Last name

Address

Phone

Pet 1 Name:

Breed:

DOB:

Pet 2 Name (If applicable):

Breed:

DOB:

Pet 3 Name (If applicable):

Breed:

DOB:

Vet Office Name:

Pet Insurance name:

Pet Insurance Policy Number:

TO WHOM IT MAY CONCERN

I hereby authorise the attending veterinarian to treat any of my pets as listed above and I accept full responsibility for all fees and charges incurred in the treatment of any of my pets.

The Pet Sitter/Dog Walker (Cookie’s Canine Comforts) is authorised to transport my pet(s) to and from the veterinary clinic (or to the closest open facility if the primary vet is not available) for treatment or to request on-site treatment if deemed necessary. If I cannot be reached in case of an emergency, the Pet Sitter/Dog Walker (Cookie's Canine Comforts) OR emergency contact listed in the new client form shall act on my behalf to authorise any treatment excluding euthanasia.

I understand that Cookie’s Canine Comforts cannot be held responsible for the results of any veterinary treatment, including; in the unfortunate event of the loss of my pet(s).

I agree to take full responsibility for payment of all charges related to the care of my pet. Cookie’s Canine Comforts are unable to provide payment of any kind for veterinary or other care.

This agreement is valid starting on the date below:

Date

Day

Month

Year

Full Name

I agree to the above statement

Veterinary Release Form

Get in Touch