AUTHORIZATION FOR EMERGENCY TREATMENT

    I will be out of town from to . I give authorization for to seek emergency medical treatment for my animal(s) while I am away.

    I authorize up to $

    I would prefer Dr. to treat my animal(s) if he/she is available and on duty on the day of the emergency.

    My emergency contact number is:

    My email address is:

    Please sign here:


    Please print your name

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