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Boarding or Absence Authorization Form
Owner's Name
Name of Animal
Age
Species
Breed
Markings
Sex
Be it known that I am the owner of the above-described animal and have the authority to execute this authorization.
During the days of
to
I hereby authorize Eastlake Veterinary Services and staff to administer treatment to my pet(s) as deemed necessary, if any medical situations arise during my pet(s) stay. I understand that there will be an attempt made to contact me, but in the event I can't be reached, I give Eastlake Veterinary Services permission to treat my pet, and I understand that I will be responsible for any charges resulting from that treatment(s). I understand that the above authorization and terms shall apply if any After-Hour emergency clinic is needed for critical or life threatening circumstances involving my pet. I am aware that Eastlake Veterinary Services is not a 24 hour facility, no staff will be on the premises after 8 pm and that my pet will be kept in a safe confined environment.
During the days listed above, my pet requires the following feeding schedule:
Food +/or container
Amount of food
# of feedings per day
Medications
I have also brought the following items, which if lost, I will not hold Eastlake Veterinary Clinic responsible
Toys/blankets/leash
Other
While I am away, I can be reached at the following telephone number
Signature of Owner
Date
12599 Colorado Blvd. Thornton, CO 80241, Phone: 303-255-8891, Fax: 303-255-1976
Copyright 2009 © Eastlake Veterinary Services, All Right Reserved
