Veterinary Release Form

In the event that any of my pets appear to be ill, injured, or at significant risk of experiencing a medical problem at the start of service or while in the care of VT Barks & Recreation, LLC, I give permission to VT Barks & Recreation, LLC to seek veterinary service from a veterinarian or a veterinary clinic. My preferred veterinary services are listed on each individual Pet Information Disclosure. Other veterinarians or emergency care clinics chosen by VT Barks & Recreation, LLC are acceptable. *

Agree

I understand that efforts will be made to contact me regarding any treatments, illness, injury, or potential problems as soon as the condition is deemed not life threatening and/or contact is possible. I understand that VT Barks & Recreation, LLC care providers work hard to prevent accidents and injuries, and that such problems may occur no matter how well a pet is cared for. I agree to allow VT Barks & Recreation, LLC care providers to use their best judgment in handling these situations, and I understand that VT Barks & Recreation, LLC and its staff assume no responsibility for the actions and decisions of the veterinary staff, the health, or death of my pet(s). *

Agree

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. Such payments will be made within 14 days of the initial incident. I also agree to be responsible for all Special Service fees assessed by VT Barks & Recreation, LLC for emergency transportation, care, supervision, or hiring of emergency caregivers, and will pay such fees within 14 days of each incident. *

Agree

I further authorize VT Barks & Recreation, LLC and my primary veterinarian(s) to share all of the medical records of all of my animals with veterinary clinics in an emergency in the interest of providing the best care for my ill or injured pet(s). Every dog at the site of service will be current (per my veterinarians recommendations) on its rabies vaccinations prior to the arrival of any caregiver. I will also make arrangements to guarantee that each pet will remain current on its rabies vaccinations throughout each service visit period. *

Agree

I agree to notify VT Barks & Recreation, LLC of any signs of injury or possible illness before any visit as soon as the condition appears. VT Barks & Recreation, LLC reserves the right to cancel service at any location where a pet with a potentially infectious condition exists. VT Barks & Recreation, LLC strives to provide clean, safe service to each of our clients. In doing so, VT Barks & Recreation, LLC strongly recommends that each pet be vaccinated, dewormed, and protected from harmful insects according to veterinarian recommended standards. *

Agree

This agreement is valid from the date below and grants permission for future veterinary care without the need for additional authorization each time VT Barks & Recreation, LLC cares for one or more of my pets. I understand that this agreement applies to all of my pets within VT Barks & Recreation, LLC care. In signing this contract, I agree that I have the sole authority to make health, medical, and financial decisions regarding the pets that will be scheduled to receive service. *

Agree

Name *

First Name

Last Name

I acknowledge that my e-signature is legally valid *

Yes

Date *

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