2 Paws Up Inc

Veterinary Notification/

Emergency Pet Care Authorization Form

This is to inform that I have contracted the services of 2 Paws Up Inc to provide pet-care services from:

Owner's Name (printed): *

Email *

Address *

City *

State *

Postal code *

Phone *

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

Veterinarian *

The client authorizes the above Veterinarian and/or Veterinary office to provide information about my pet's health and treatment options to 2 Paws Up Inc should veterinary care be necessary in my absence.

Additionally, I agree that I accept financial responsibility for the emergency care of my pet (s) and will be responsible for the payment of your veterinary services. Payment information, including any limits on the authorized payment amount, are documented at the bottom of this form.

Name of Pet(s) *

Additional Instructions

I authorize emergency veterinary care costs up to: *

Authorization for euthanasia:

I DO NOT authorize euthanasia without my direct consent.

In the event of my pet's death, I wish for the following to be done with his/her remains:

Please note any other exclusions to the type of care you authorize in your absence:

Payment Method

Vital Security Details Concerning Credit Card Information

For security reasons, it's crucial not to include your credit card information when submitting this form to our office.

Only input your credit card details on your printed document that is to be placed inside your sealed envelope.

If you have any concerns about payment processes, don't hesitate to reach out to 2 Paws Up Inc office for clarification.

Name on Card:

Credit Card Number

Expiration (Month and Year):

CSC/CVV:

IMPORTANT INSTRUCTIONS:

Seal the Form: Place the completed form inside an envelope. Ensure that all necessary documents are included, such as a copy of your pet’s medical records if required.

Label the Envelope: Clearly write on the envelope: “For Veterinarian Emergency Care Only”. This label indicates that the envelope should only be opened by the veterinarian or their staff in an emergency situation.

Keep a Copy: It’s a good idea to keep a copy of the filled-out form and any other relevant documents for your records. This can be helpful for future reference or in case the original documents are misplaced.

By following these steps, you ensure that your pet sitter is prepared and authorized to act in the best interest of your pet during an emergency, facilitating timely and appropriate medical care.

I hereby acknowledge that I have read and fully understand the contents of this document.

Owner's Signature:

Date