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Veterinary Authorization
Please fill out a separate form for each pet IF the information varies per pet
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* Indicates required question
Email
*
Your email
Pet Name(s)
*
Your answer
Primary Veterinarian Information
*
Your answer
Emergency Veterinarian Information
*
Your answer
I give total responsibility for the care of my pets to: West LA Pawfect Pet Sitting and Cierra Voelkl. When I cannot be contacted immediately, this person will make all decisions regarding necessary treatment in the event of a medical emergency.
*
Yes
No
I wish to spend no more than the following on a single pet
Your answer
If any of my pets dies suddenly, I do/do not want a
necropsy
performed to determine the cause of death. In the event of death:
*
I DO want a post mortem performed to determine cause of death
I DO NOT want a post morterm performed to determine cause of death
Other:
In the event of sudden death, I would like my pet to be:
*
Privately
Cremated communally
Brought home for burial
To be discussed at time of event
Other:
Date
*
MM
/
DD
/
YYYY
Please type your name to verify that you have read, understand and agree to the above agreement
*
Your answer
A copy of your responses will be emailed to the address you provided.
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