The Right Steps & Cindy C. Smith

VETERINARIAN AUTHORIZATION

Vet_____________________________________ Pets Name/Names_________________________________________________

During my various absences, The Right Steps & Cindy C. Smith will be caring for my animal(s). They have my permission to transport them to and from your office or, in the case of large animals, request "on site" treatment from your office as is deemed necessary. I authorize you to treat my animal(s) and I will be fully responsible for all fees and charges and will pay for all charges incurred on my behalf upon my return.  I further authorize you to give out any information about my animal(s) to Cindy C. Smith, the owner of The Right Steps.

Client Initials_________________

The Right Steps

Urgent Veterinary Treatment Authorization

This form will be retained on file and will be used to authorize urgent veterinary treatment in the event that your pet(s) require such treatment during your absence and we are unable to contact you at the time.  Should you change vets please notify The Right Steps & Cindy C. Smith before service dates.

Client Name:_______________________________________________________________________

Address:___________________________________________________________________________

City: ____________________________ ZIP:________________

Home Telephone:  _____________________   Work Telephone: ___________________ Mobile/Pager:    _____________________

To whom it may concern: I have contracted for services from The Right Steps & Cindy C. Smith during my absence and I authorize The Right Steps & Cindy C. Smith to act on my behalf to request veterinary treatment and services when they deem it necessary. I accept full responsibility for charges incurred in the treatment of my pet(s):

Special Instructions: _______________________________________________________________________________

Dollar limit per pet on emergency care: $ ______________________________________________________________

The Right Steps & Cindy C. Smith  reserves the right to utilize the services of any available veterinary clinic.

I authorize you to treat my animal(s) and I will be fully responsible for all fees and charges and will pay for all charges that are incurred on my behalf, immediately upon my return.

____________________________________           _____________________          ______________________________________

Client                                                          Date                                         The Right Steps & Cindy C. Smith

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