Garrett PetMinders - P.O. Box 2415, Mountain Lake Park, MD 21550
Jay Clark: 301.334.2950 / Kathleen Gibbs: 301.334.0674
www.garrettpetminders.com / Email: garrettpets@verizon.net
VETERINARIAN AUTHORIZATION
(Please sign one copy for each pet)
Vet: PineView Veterinary Hospital Pets Name/Names_________________________________________________
During my various absences, Garrett PetMinders will be caring for my animal(s). They have my permission to transport them to and from your office or, in the case of large animals, request "on site" treatment from your office as is deemed necessary. I authorize PineView Veterinary Hospital to treat my animal(s) and I will be fully responsible for all fees and charges and will pay for all charges incurred on my behalf upon my return. I further authorize you to give out any information about my animal(s) to Kathleen Gibbs or Jay Clark, the owners of Garrett PetMinders.
Client Initials_________________
Garrett PetMinders
Urgent Veterinary Treatment Authorization
This form will be retained on file by Garrett PetMinders and will be used to authorize urgent or emergency veterinary treatment in the event that your pet(s) require such treatment during your absence and we are unable to contact you at the time. Should you change vets please notify Garrett PetMinders before our next visit.
Client Name:_______________________________________________________________________________________________
Address:_____________________________________________________________________________________________
City & State: ___________________________________________________________________________ ZIP:________________
Home Telephone: _____________________ Work Telephone: ___________________
Mobile/Pager: _____________________
To whom it may concern: I have contracted for services with Garrett PetMinders during my absence and I authorize Garrett PetMinders or it’s duly authorized representative to act on my behalf to request veterinary treatment and services when, as and how they deem it necessary. I accept full responsibility for charges incurred in the treatment of my pet(s):
Special Instructions: ____________________________________________________________________________________________________
I, ___________________________________________________________________ authorize PineView Veterinary Hospital to treat my animal(s) and I will be fully responsible for all fees and charges and will pay for all charges that are incurred on my behalf, immediately upon my return.
Client: _____________________________________________________________________________
Date: ______________________________________________________
Jay Clark: 301.334.2950 / Kathleen Gibbs: 301.334.0674
www.garrettpetminders.com / Email: garrettpets@verizon.net
VETERINARIAN AUTHORIZATION
(Please sign one copy for each pet)
Vet: PineView Veterinary Hospital Pets Name/Names_________________________________________________
During my various absences, Garrett PetMinders will be caring for my animal(s). They have my permission to transport them to and from your office or, in the case of large animals, request "on site" treatment from your office as is deemed necessary. I authorize PineView Veterinary Hospital to treat my animal(s) and I will be fully responsible for all fees and charges and will pay for all charges incurred on my behalf upon my return. I further authorize you to give out any information about my animal(s) to Kathleen Gibbs or Jay Clark, the owners of Garrett PetMinders.
Client Initials_________________
Garrett PetMinders
Urgent Veterinary Treatment Authorization
This form will be retained on file by Garrett PetMinders and will be used to authorize urgent or emergency veterinary treatment in the event that your pet(s) require such treatment during your absence and we are unable to contact you at the time. Should you change vets please notify Garrett PetMinders before our next visit.
Client Name:_______________________________________________________________________________________________
Address:_____________________________________________________________________________________________
City & State: ___________________________________________________________________________ ZIP:________________
Home Telephone: _____________________ Work Telephone: ___________________
Mobile/Pager: _____________________
To whom it may concern: I have contracted for services with Garrett PetMinders during my absence and I authorize Garrett PetMinders or it’s duly authorized representative to act on my behalf to request veterinary treatment and services when, as and how they deem it necessary. I accept full responsibility for charges incurred in the treatment of my pet(s):
Special Instructions: ____________________________________________________________________________________________________
I, ___________________________________________________________________ authorize PineView Veterinary Hospital to treat my animal(s) and I will be fully responsible for all fees and charges and will pay for all charges that are incurred on my behalf, immediately upon my return.
Client: _____________________________________________________________________________
Date: ______________________________________________________
