Owner Absentee Authorization Form

Complete this form if you are going out of town and need to designate a guardian or authorize someone to care for your pet(s). This ensures that if someone else brings in your pet, we know they have permission to authorize necessary treatments and care.

First Name*:

Last Name*:

Email:

Phone:

Pet Name(s)

I authorize the following person(s) to make decisions regarding the care of my pet(s) while I am deployed or otherwise unavailable.*

Yes

Authorized Pet Guardian

First Name*

Last Name*

Phone*

Secondary Phone

Address*

Address, Line 2

City*

State / Province / Region*

Zip / Postal Code*

Country*

Authorized to make End of Life decisions?*

Yes

If Primary Owner is unavailable – authorized to make End of Life decisions?*

Yes

Add secondary Authorized Pet Guardian?*

Yes

Payment

Payment is full is due at time of services rendered. I authorize using my card on file for services performed.*

Owner Absentee Authorization Form

Authorized Pet Guardian

Payment

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