Red River K9 II Veterinary Consent

Further vet. River

Owner's Name *

First

Last

Dog(s) name(s): *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Emergency contact *

First

Last

Phone *

Name of primary Clinic *

Clinic Phone *

Does your dog have any allergies, injuries or any other medical concerns that we should be made aware of? *

no
yes

if yes, please explain:

If my dog(s) become ill or if the state of my dog(s) health otherwise requires professional attention, Red River K9 II LLC, in it's sole discretion, may engage the services of a veterinarian or administer medicine/give other requisite attention to my dog(s) in their best interest. I accept responsibility for any expenses in-cured. I understand that Red River K9 II LLC will make every effort to contact me in the event that my dog needs any medical attention. I give Red River K9 II LLC permission to take my dog(s) that are listed above to the clinic registered on file with Red River K9 II LLC. If it is more convenient, I give permission to Red River K9 II LLC to take my dog(s) to the nearest veterinary clinic for medical treatment in my absence. I agree to pay all charges associated with a visit to the vet. Only as a last resort, I give permission for Red River K9 II LLC to take my dog to the nearest Emergency Vet. I agree to pay all charges associated with a visit to the vet. I hereby authorize the attending veterinarian to release all medical records, medical treatments, along with treating my dog(s) listed above while under the care of Red River K9 II LLC. I accept full responsibility for all fees and changes that are incurred for treatment or required medications for any dog(s) listed above. Red River K9 II LLC is authorized to transport my dog(s) to and from the veterinary clinic or hospital for treatment as deemed necessary. If I cannot be reached in case of an emergency, Red River K9 II LLC shall act on my behalf to authorize treatments. Authorization will be utilized from the time of authorization through the term of all services with Red River K9 II LLC. *

yes

I authorize the use of appropriate anesthesia and pain relief medication as needed before and after any procedure. I have been informed that there are risks associated with the use of any medications. *

I Further agree that my dog(s) shall not leave Red River K9 II LLC until all charges are paid to Red River K9 II by the owner of said dog(s) *

yes

This Veterinary Consent Form contains the entire agreement between the below signed parties. All terms and conditions of this contract shall be binding and the heirs, administrators, personal representatives and assigns of Owner and Red River K9 II LLC.

Signature *

Clear Signature

Date / Time *

Date

Time