Pet Care Emergency Authorization Form

The authorized agents listed on this form are authorized to make emergency veterinary medical decisions for the animal(s) described below in the event that I cannot be reached. Where applicable, I have also listed guidelines and limitations of care. Financial responsibility for the emergency care of the animal(s) listed below will be handled by the authorized representative.
  • Date Format: MM slash DD slash YYYY
  • I authorize the agent(s) listed on this form to make emergency veterinary medical decisions for the animal described below in the event that I cannot be reached. Where applicable, I have also listed guidelines and limitations of care.
  • Owner’s contact information in case of emergency (provide all forms of contact).
  • Other contacts (travel companions, etc. – name and contact information).

  • Pet information

  • List all pets this forms applies to

  • Authorized agents information

    Authorized agents MUST be 18 years of age or older.