Street Address

Alexandria, VA

Phone Number

Your Custom Text Here

In the event of a medical emergency where Faff's Furry Friends cannot contact you to authorize care immediately and directly, Faff's Furry Friends will use this form to obtain care. It is recommended that you place a credit card on file with your vet and advise them we will be caring for your pets. A copy of this form will be brought to your vet if a situation arises where veterinary care is needed.

Primary Veterinarian Information

Name of Vet/Hospital/Clinic

Address

Phone

(###)

###

####

Name of Preferred Doctor

I hereby give Faff's Furry Friends my express permission to transport any of my pets for care to the above mentioned veterinarian (or to closest open facility if the Primary Vet office is not available). I understand that Faff's Furry Friends will try to contact me as soon as possible in the event of a medical emergency. If Faff's Furry Friends cannot contact me, I give permission to Faff's Furry Friends to make medical treatment decisions and approve charges. I give permission for the hospital/clinic/doctor to administer any care or medications necessary. I will assume full responsibility for the payment and/or reimbursement for any and all veterinary services rendered, including but not limited to diagnosis, treatment, grooming, medical supplies, and boarding. I also agree to be responsible for all fees assessed by Faff's Furry Friends for emergency transportation, care, supervision, or hiring of emergency caregivers. Such payments will be made within 5 days of my return.

First Name

Last Name

Date

YYYY