Veterinary Treatment Authorization Form
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1Caring Paws Pet Sitting Services,
LLC
Veterinary Treatment Authorization
Client Name: _________________________________________________________________
Address: ____________________________________________________________________
City: ________________________________________ ZIP: _________________________
Home phone: _________________________ Work phone: ____________________________
Cell: ________________________________ Other: ________________________________
This form will be retained on file and will be used to authorize veterinary treatment in the event
that your pet(s) require treatment during your absence, while in our care, and we are unable to
contact you at the time. Should you change veterinarians please notify Caring Paws before
service dates.
To whom it may concern: During my absence a representative of Caring Paws will be caring
for my pet(s). I give Caring Paws my permission to transport my pets to my veterinarian or to
an emergency clinic. In the event I cannot be reached, I authorize Caring Paws to act as an
agent on my behalf regarding my pets’ medical care. I accept full responsibility for charges
incurred in the treatment of my pet(s), not to exceed the following amounts for each pet:
Pet(s) Name
Maximum Amount
Specific Limits of Care?
____________________
$______________
___________________________________
____________________
$______________
___________________________________
____________________
$______________
___________________________________
____________________
$______________
___________________________________
Caring Paws reserves the right to utilize the services of any available veterinary clinic. If time
permits, I will attempt to utilize your primary veterinary clinic. If it is not practical to do so, the
following information will be helpful if the clinic we utilize requires documentation from your
primary clinic.
Veterinary Clinic: _____________________________________________________________
Address: ____________________________________________________________________
City: ________________________________________ ZIP: _________________________
Phone: ____________________________ Emergency Phone: _________________________
I authorize veterinary treatment for my animal(s) during my absence. I understand that Caring
Paws assumes no responsibility for the loss of any pet and is released from all liability related to
transportation, treatment and expense. I will be responsible for any and all charges incurred
during treatment of my pet(s) to the maximum amounts and specific limits of this authorization.
Signature: ___________________________________________ Date: __________________
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