EMERGENCY VETERINARY AUTHORIZATION FORM FOR PET CARE (TEMPLATE)

This is a general template, not legal or veterinary advice. Requirements and
clinic policies vary. Have a licensed attorney in your state review your form,
and ask the pet's regular veterinarian what authorization it will accept.

OWNER
Full name: _________________________________________________
Phone: _______________________  Email: ______________________
Travel dates or dates unavailable: __________________________

BACKUP DECISION-MAKER
Name: ______________________________________________________
Relationship to owner: _____________________________________
Phone: _______________________  Email: ______________________

PET
Name: ________________________  Species: ____________________
Breed: _______________________  Date of birth/age: __________
Microchip number, if any: ___________________________________
Known conditions, allergies, and medications: ______________
_____________________________________________________________

REGULAR VETERINARIAN
Clinic: _____________________________________________________
Veterinarian: _______________________________________________
Phone: _______________________  After-hours phone: __________

PREFERRED EMERGENCY CLINIC
Clinic: _____________________________________________________
Phone: _______________________  Address: _____________________

AUTHORIZATION
If my pet becomes ill or injured while in the care of
[Sitter or business name], I authorize the sitter to:

[ ] Transport my pet to the regular veterinarian named above.
[ ] Transport my pet to an emergency veterinary clinic when the regular
    veterinarian is unavailable or the sitter reasonably believes the need
    is urgent.
[ ] Approve examination, diagnostics, stabilization, medication, and
    treatment up to a total of $____________ if neither I nor my backup
    decision-maker can be reached after reasonable attempts.

If the veterinarian believes the expected cost will exceed that amount and I
still cannot be reached, my instructions are:
_____________________________________________________________
_____________________________________________________________

PAYMENT AND REIMBURSEMENT
I accept financial responsibility for veterinary care authorized under this
form and agree to reimburse the sitter for veterinary charges the sitter pays
on my behalf. My payment arrangement with the clinic is:

[ ] The clinic has my payment method or billing instructions on file.
[ ] The clinic should contact me or my backup decision-maker for payment.
[ ] Other: __________________________________________________

The dollar amount above is the maximum the sitter may approve without further
permission. It is not a guarantee that a clinic will extend credit, accept this
form, or limit charges to that amount.

RECORDS AND COMMUNICATION
I authorize the veterinarian to share records and treatment information needed
for this emergency with the sitter and my backup decision-maker, subject to
applicable law and clinic policy.

OWNER SIGNATURE
I confirm that the information above is accurate and that I am the pet's owner
or am authorized to make these decisions.

Owner signature: ____________________________________________
Printed name: _______________________________________________
Date: _______________________  Authorization expires: ________

SITTER
Name or business: ___________________________________________
Phone: _______________________  Email: ______________________

Before the care dates, the owner and sitter should give a copy to the regular
veterinarian and confirm the clinic's current authorization and payment rules.

Houndtrust LLC provides this template for general information and convenience
only. It is not legal or veterinary advice, creates no attorney-client or
veterinarian-client-patient relationship, and comes with no guarantee that a
clinic or court will accept it. Laws and clinic policies vary. Have a licensed
attorney in your state review and adapt it before use.