Treatment Authorization
Form for Pet-sitter

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Owner’s Information:

Owner’s Name: *

First

Last

Owner's Phone Number While AWAY *

Departure and Return Dates *

Pet Sitter’s Information:

Agent's/Petsitter's Name, in absence of owner

First

Last

Agents/Petsitters Phone Number *

The agent above is responsible for my pet(s) while I am away and

I grant my Agent power to make all decisions regarding veterinary care without contacting me first.
I wish to be contacted before any non-emergency treatments; however, I give permission for my Agent and this hospital to provide lifesaving, emergency treatments while I am contacted or in the event I am unable to be reached.
I wish to be contacted before all treatments, regardless of emergency or non-emergency nature. I am aware this means medical care will be withheld from my pet, including possible lifesaving treatments.

Consent to Treatment

I, the undersigned, am the owner or agent for the owner of the animal described above. I have the full and exclusive authority to execute this consent and am over 18 years of age.

I give permission to doctors, staff, authorized agents, or representatives of Melrose Veterinary Hospital to hospitalize, anesthetize, medicate, treat, or perform surgery on my pet.
I am aware of the risks and complications associated with any surgery, anesthesia, hospitalization, procedure, and medications that may be given or dispensed for my pet.
I further understand that unforeseen conditions may arise that may necessitate additional procedures at an additional cost.
If life-saving emergency care is required, I authorize this hospital's doctors, staff, authorized agents, or representatives to provide treatment which they deem necessary until I can be reached.
I authorize the use of appropriate anesthesia and pain relief medication as needed before and after the procedure.
I understand that if my pet remains hospitalized, there will not be overnight supervision provided.
I further understand that it can be very stressful to an animal to be hospitalized and this stress may cause underlying physical conditions to become apparent. This can result in illness and even death. While the hospital strives to provide the best in veterinary services; unfortunately, no guarantee can be made regarding the outcome of the services provided. Irelease the hospital from any and all liabilities.

Owner’s signature *

Clear Signature

Date *

For treatments amounting up to $ *

Payment Methods

Please charge my credit card for treatment
The agent/petsitter will be paying for treatment.

Owner’s signature *

Clear Signature

Date *

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Questions?

Get in touch! We look forward to hearing from you.

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Location

1680 South Melrose Dr.
Suite 104
Vista, CA 92081

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Contact Information

P: (760) 727-5151
F: (855) 287-5760
E: melroseveterinaryhospital@gmail.com

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Hours

Mon, Wed, Fri: 7:30am – 6:00pm
Tues, Thu: 7:30am – 7:00pm
Sat: 8:30am – 4:00pm
Sun: Closed

Name *

First

Last

Email *

Phone

How can we help you? *

Website

Treatment AuthorizationForm for Pet-sitter

Owner’s Information:

Pet Sitter’s Information:

Consent to Treatment

Treatment Authorization
Form for Pet-sitter