Veterinary Release Form - download
Soma’s Pet Services, Inc. requires all clients to complete a Veterinary Release Form. In the event of an emergency, Soma’s Pet Services, Inc. will make every attempt to contact the owner, the secondary owner, and/or the emergency contact.
In the event that no contact can be reached, Soma’s Pet Services, Inc. will seek appropriate medical care for your pet(s). Soma’s Pet Services, Inc. will make every attempt to take your pet(s) to the Veterinarian listed blow, however, if your veterinarian is not available, Soma’s Pet Services, Inc. will bring your pet(s) to an appropriate clinic.
Veterinarian Information
Veterinarian Name: __________________________________________
Office Name: __________________________________________
Address: ___________________________________________
__________________________________________
Office Phone: ___________________________________________
Other Phone: ___________________________________________
I __________________________________, agree to the following:
1. In the case of an emergency, I understand that Soma’s Pet Services, Inc. make every attempt to contact the primary owner, secondary owner, and/or emergency contact.
2. If no contact can be reached, I authorize Soma’s Pet Services, Inc. to seek appropriate medical treatment for my pet(s).
3. I understand that every effort will be made to take my pet(s) to the above Veterinarian, however, I authorize Soma’s Pet Services, Inc. to seek treatment for my pet(s) any appropriate clinic, if necessary.
4. I give permission to Soma’s Pet Services, Inc. to approve treatment up to:
___No limit ___$250 ___$500 ___$1000 ___other $_______
5. I authorize Soma’s Pet Services, Inc. and the Veterinarian caring for my pet(s) to share all medical records of my pet(s) with emergency vet clinics in an effort to provide the best care possible.
6. I agree to assume full responsibility for payment and reimbursement for any and all veterinary services rendered.
7. I understand that Soma’s Pet Services, Inc. assumes no responsibility for the loss or injury of any pet(s) and is released from all liability related to transportation, treatment, and expenses.
8. This agreement is valid from the date below and grants permission for all future veterinary care without additional authorization each time Soma’s Pet Services, Inc. cares for my pet(s).
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Signature
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