Please fill in Owner's Name and Authorized Agent's Name.
Owner's Name *
Owner's Name
Owner's Phone
Owner's Phone
(travel companions, etc. - name and contact information)
Sex
Microchip
Please list the medication names, dosage, frequency, how it's given (orally, etc), and any other notes
Other instructions, if applicable:
$
The Doctors and Staff at New Frontier Animal Medical Center recommend that the regular Veterinarian and Pet sitter both have a copy of this Permission to Treat Authorization form on file in the owner’s absence.
Forms for long term or permanent care must be renewed quarterly.
If the caregiver is permanent, this person can be added to the medical record as an additional contact. Please be advised that this contact will have full access to all information pertaining to the account before adding a caregiver. It will then become the pet owner/account holder’s responsibility to remove the caregiver should the arrangement change.