Authorization To Treat

I hereby authorize Frontier Veterinary Hospital to make medical and health care decisions for my pet(s) (listed below) in my absence. In the event of an emergency, I understand that Frontier Veterinary Hospital (FVH) will attempt to contact me at the phone number(s) provided; however, I understand that if I cannot be reached within a reasonable amount of time (as determined by FVH based on urgency of medical care), I authorize FVH to treat my pet however is deemed necessary for its health and well-being. Furthermore, I agree to pay for any and all expenses that may be incurred. *

I have read and authorize

Pets included in authorization (please note any special medical concerns): *

Dates this Authorization is valid (or indicate if this authorization is ongoing): *

Phone number(s) to contact owner(s): *

Name of person(s) authorized to make medical decisions: *

Phone number(s) of person(s) authorized to make medical decisions: *

In the unlikely event that your pet is facing an urgent and immediate life-threatening condition, we will do everything in our power to ensure his or her continued comfort. If your wishes are a humane end to their suffering, please initial below. *

Yes, if the doctor feels that recovery is not possible.
No, please keep my pet comfortable until I return.

Digital Signature (Name) *

First

Last

E-mail *

Today's Date *

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