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:
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Today's date
By submitting this form, you agree to be contacted via the info given through email, phone call, or text message
