Emergency Consent Form

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Without consent from an authorized agent we are able to provide only supportive care for your animal. We are unable to perform diagnostic testing and provide more necessary and many times life saving care. Thank you for taking the time to be proactive for the care of your animal.

Contact Name:

First Name: Last Name:

Email:

Emergency Phone Number:

Animal(s) Name:

In case an emergency occurs when I, the owner, cannot be reached, I hereby authorize the attending agent(s) to request emergency services from REDMOND VETERINARY CLINIC for the specified animal(s) or any other animals I may own at that time. I agree to pay for such Veterinary care, not to exceed amount listed below within a thirty-day period. If the bill for such services is not paid within this time period, it may be billed to my credit card.

Do not exceed:

Consent to authorize emergency care:

I Consent

I Consent with provisions stated below

Provisions to treatment:

Please indicate the duration that you would like to make this form valid

A staff member may contact you to obtain a Credit Card to provide payment should an emergency occur. Thank you.

Redmond Veterinary Clinic 1785 N. Hwy 97 Redmond, OR 97756 (541) 548-1048 Fax (541)548-2323 e-mail us | site map | Employees Only

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