Caring for life...caring for a lifetime.
Authorization for Medical Care during Owner's Absence
1. I hereby give permission for (name of responsible party) ) to bring
my animals to Four Seasons Animal Hospital for treatment and/or surgery that may become necessary
during my absence from: (dates) to .
2. This authorization applies to the following animals:


3. In the event of a terminal illness or at the discretion and concurrence of both the doctor and the
responsible party named above, I also give permission for euthanasia.
4. I agree to be responsible for all charges and authorize the following expense:
  As needed for my pet's wellness and well-being
  Up to a limit of $
5. Payment will be made as follows:
  I have left a check with the above designated responsible party for payment of all charges.
  I will call your office and provide a credit card.
6. Special instructions or requests:



Signature Date
Address City State
Phone #1 Phone #2
Email