Consent for Emergency Care

Please fill out the consent form below, and a member of our team will get back to you shortly. If you have any questions, please feel free to contact us.

APPOINTMENT

Consent for Emergency Care Form

Please note any fields with * are required.

I hereby authorize Carolinas Veterinary Care Clinic to make medical and health care decisions for my pet(s) (listed below) in my absence. In the event of an emergency, I understand that Carolinas Veterinary Care Clinic will attempt to contact me at the phone number(s) provided; however, I understand that if I cannot be reached within a reasonable amount of time (as determined by Carolinas Veterinary Care Clinic based on the urgency of medical care), I authorize Carolinas Veterinary Care Clinic to treat my pet however is deemed necessary for its health and well-being. Furthermore, I agree to pay for any and all expenses that may be incurred. *

I have read and authorize

Pets included in authorization (please note any special medical concerns): *

Dates this Authorization is valid (or indicate if this authorization is ongoing): *

Phone number(s) to contact owner(s): *

Name of person(s) authorized to make medical decisions: *

Phone number(s) of person(s) authorized to make medical decisions: *

In the unlikely event that your pet is facing an urgent and immediate life-threatening condition, we will do everything in our power to ensure his or her continued comfort. If your wishes are a humane end to their suffering, please initial below. *

Yes, if the doctor feels that recovery is not possible.
No, please keep my pet comfortable until I return.

Owner's Name *

First

Last

Owner's Signature *

Clear Signature

E-mail *

Today's Date *

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Consent for Emergency Care

Consent for Emergency Care Form

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