Veterinarian Release

First Name*
Last Name*
Date*
Date Format: MM slash DD slash YYYY
Phone*
Address*
City*
State*
Zip*
Vet Info
Vet name*
Hospital*
Address*
City*
State*
Zip*
Phone Number*
TO THE HOSPITAL:

During my absence, a representative of Bark to Basics will be caring for my pet(s) and has my permission to transport them to your office for treatment. I authorize you to treat my pet(s) and will be responsible for payment to you upon my return.

Please file this form with my records.
Pet's Name(s)*
Untitled*
I,
pet owner, hereby give Bark to Basics my express permission to transport my pet(s) for care to the above-mentioned veterinarian (or to the closest facility in the event of emergency). I give permission for the hospital/clinic/doctor to administer whatever care/medications necessary to care for my pet(s), with the exclusion of the following:
Pet Owner*
Date
Date Format: MM slash DD slash YYYY
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Vet Info