MEDICAL
TREATMENT
RELEASE
FORM
I
(we) the undersigned owner(s) of _____________________, my dog, do
hereby authorize and consent to such medical services or care which are
necessary or appropriate for my dog, including the selection of
veterinary personnel and facilities and transportation or transfer of my
dog to such facilities and in connection with such treatment, services
and/or care, to authorize and consent in my name and on my behalf to
such emergency or necessary surgery, diagnostic or corrective, as they
may determine to be necessary for the life, health or well being of my
dog, after reasonable consultation with duly licensed veterinarians. It
is understood that reasonable effort shall be made to contact the
undersigned prior to rendering treatment to my dog but that any of the
above treatment will not be withheld if the undersigned cannot. be
reached.
Owner
Name
Signature
1: ______________________________Date: _____________
Name
1 (print): ____________________________
Owner
Name
Signature
2: ______________________________Date: _____________
Name
2 (print): ____________________________