Aurora Veterinary Clinic

305 Aurora Commons Circle
Aurora, OH 44202

(330)562-5100

www.auroravet.com

Permission to Treat / Consent

Pet Owner(s) Name (required)
First Name (required)
Last Name (required)
Today's Date (required) :
Address (required)
Street Address (required)
City (required)
,
State / Province (required)
Zip / Postal Code (required)
E-Mail Address (required) :
Home Phone
Phone TypePhone Number
Cell Phone (required)
Phone TypePhone Number (required)
Expected Date(s) of Absence (required)

Pet's Name(s) (required)

Pet Sitting Caretaker (required)
First Name (required)
Last Name (required)
Caretaker's Address (required)
Street Address (required)
City (required)
,
State / Province (required)
Zip / Postal Code (required)
Caretaker's Home Phone
Phone TypePhone Number
Caretaker's Cell Phone (required)
Phone TypePhone Number (required)

I, the owner of the above-named pet(s), request that the above pet sitting caretaker feed, exercise, groom, and provide routine care for my pet(s) while I am away from home per my oral or written instructions. Should an injury or illness occur to my pet(s) that requires veterinary care during my absence, I authorize the pet sitter to act as my agent in procuring veterinary care, we fees not to exceed:
(required)


I agree to pay the fees for such professional veterinary services as soon as possible after I return and, in the absence of gross negligence, will not hold the pet sitter liable for injuries or illnesses suffered by my pet(s) or any fees for veterinary services incurred on their behalf.
The address and phone number(s) where an authorized agent of mine or I may be reached are:

Do you, or do you not authorize intensive medical care efforts for your pet(s)? (required)

I do authorize
I do not authorize


Have you, or have you not contacted your pet's local veterinarian and, therefore, he/she is aware or unaware that you will be absent and that the above pet sitter may seek veterinary services in my absence? (required)

I have, & he/she is aware
I have not, & he/she is not aware


My veterinary practice of choice is: (required)

In the event the attending veterinarian determines that your pet is suffering and/or is incurably injured, do you give your consent for euthanasia? (required)

I give my consent
I do not give my consent


If your pet should pass away or is euthanized, please select from the following options: (required)

I request that the body be retained until I return (I agree to pay fees for services)
I request that the body be individually cremated w/ ashes returned to myself (I agree to pay fees for services)
I request that the body be communally cremated (I agree to pay fees for services)



By submitting this form, I agree that all the above information is true and that this submission qualifies as my electronic agreement.

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