Medical Authorization & Release

Human Client Name*
Street Address, City, State, Zip Code*
Email*
Phone*
Medical Authorization & Release*
- I hereby give permission for Cats in the City, LLC to care for my pet in my absence. I authorize any licensed animal medical center or licensed practitioner to treat my pets in a manner that is best suited to the condition being treated. Cats in the City is permitted to transport my pets to and from your clinic, request “on-site” treatment at their facilities, and/or coordinate treatment via telephone, fax, and email. I authorize the transfer of records to other animal medical centers to improve coordination of care. I accept full responsibility for all fees and charges, and we will pay all fees and charges immediately. I authorize Cats in the City to use our credit card on file or we will reimburse them for all fees that arise. I release Cats in the City from all liability associated with any medical and pet care decisions.
eSignature (Please Type Name)*
Comments
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