Treatment Authorization Form

Name: Veterinarian
Brand: Briar Patch Veterinary Hospital

Owner's Name:

First

Last

Email Address:

Phone Number:

Pet Name(s):

The following individuals have my permission to bring my pets to Briar Patch for any treatment needed while I am out of town.

Caretaker:

I will be gone from:

I will return on:

I can be reached for major medical decisions at the phone and email listed above. All minor medical decisions can be made by the above named individuals.

Special Instructions:

Owner Signature

Sign above

Treatment Authorization Form

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