Absent Owner Authorization Form Date Date Format: MM slash DD slash YYYY Name First Last Pet(s) Name(s)I authorize to make emergency veterinary medical decisions for pets described above, in the event that I cannot be reached. Where Applicable, I have also listed guidelines and limitations of care. I understand that as owner, I am responsible for any financial costs for the veterinary care provided to my pet(s).Authorized agent's nameContact information in case of an emergencyPhone NumberEmail Alternate Phone NumberOtherAuthorized Agent's name and phone numberThe authorized agent is responsible for my pet(s) (please check one)Only during the time frame indicated.Anytime I am unable to bring my pet(s) to your facilityDeparture Date & Return DatePlease check all boxes that are applicable I authorize emergency veterinary care costs I grant the authorized agent the ability to make all veterinary medical decisions including euthanasia I do NOT authorize euthanasia without my direct consent Please contact me before any veterinary services are administered.Up to $Phone numberDigital Signature
