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1. Pet Owner Information: Contact details and identification of the pet owner including name, address, phone numbers and email
2. Pet Information: Details of the pet including species, breed, age, name, sex, microchip number and any identifying marks
3. Authorization Statement: Clear statement authorizing veterinary professionals to provide medical treatment and perform necessary procedures
4. Emergency Contact Details: Alternative contacts if owner cannot be reached during an emergency
5. Financial Responsibility: Statement confirming owner's responsibility for all costs associated with treatment
1. Special Care Instructions: Additional section for pets with specific medical conditions, allergies, or special care requirements
2. Treatment Limitations: Section specifying any restrictions on treatments or procedures the owner does not authorize
3. Euthanasia Authorization: Section authorizing or restricting euthanasia decisions in emergency situations
1. Medical History: Schedule containing pet's previous medical records, conditions, and treatments
2. Vaccination Records: Schedule detailing current vaccination status and history
3. Medication List: Schedule listing current medications, dosages, and administration instructions
Authorized Agent
Emergency Contact
Veterinary Practice
Veterinary Professional
Treatment
Emergency Treatment
Medical Procedures
Pet
Medical Records
Authorization Period
Reasonable Costs
Emergency Circumstances
Euthanasia
Treatment Limitations
Medical History
Vaccination Records
Authorized Services
Treatment Facility
Treatment Provider
Financial Responsibility
Emergency Contact Authorization
Liability Release
Medical Information Disclosure
Treatment Limitations
Treatment Decisions
Cost Limitations
Duration of Authorization
Termination Rights
Confidentiality
Data Protection
Medical Records Access
Euthanasia Authorization
Insurance Requirements
Indemnification
Governing Law
Dispute Resolution
Amendment Rights
Severability
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