VETERINARIAN RELEASE FORM

VETERINARIAN NAME & HOSPITAL:________________________________________________

ADDRESS:_____________________________________________________________________

PHONE NUMBER(S):_____________________________________________________________

TO THE VETERINARIAN/CLINIC/HOSPITAL:

During my absence, a representative of the Doggie Nanny will be caring for my pet(s) and has
my permission to transport them to your facility for treatment.
I authorize you to treat my pet(s) and will be responsible for payment to you upon my return.

PLEASE FILE THIS FORM WITH MY RECORDS

PET OWNER:___________________________________________________________________

ADDRESS:_____________________________________________________________________

PHONE NUMBER(S): HOME: _________________________________________

CELL: ________________________ OFFICE: ________________________________________

(Hospital or veterinarian may require the following information)

Method of payment to Veterinarian: Credit Card_____ Check_____ Cash_____

PET NAMES:______________________________________________________________

I, ___________________________ (PET OWNER) HEREBY GIVE “The Doggie Nanny”
MY EXPRESS PERMISSION TO TRANSPORT MY PET(S) FOR CARE TO THE ABOVE LISTED
VETERINARIAN (OR TO CLOSEST FACILITY) IN EVENT OF EMERGENCY).
I GIVE PERMISSION FO RTHE HOSPITAL/CLINIC/DOCTOR TO ADMINISTER WHATEVER
CARE/MEDICATIONS NECESSARY TO CARE FOR MY PET(S) WITH THE EXCLUSION OF THE FOLLOWING:

___________________________________ _______________________________________

Pet Owner Date The Doggie Nanny Date

VETERINARY INSTRUCTIONS AND RELEASE FORM

Pet’s Name:___________________________________________________________
Description:_______________________________________________Age:_________
Medical conditions/medication:_____________________________________________
______________________________________________________________________

Pet’s Name:___________________________________________________________
Description:_______________________________________________Age:_________
Medical conditions/medication:_____________________________________________
______________________________________________________________________

If the above named pet(s) becomes ill or is injured, I request that The Doggie Nanny Inc.

take the pet to:

Veterinary Office Name:______________________________________________________
Address: ___________________________________________________________________
Phone Number: _____________________________________________________________

TO THE VETERINARIAN/CLINIC/HOSPITAL:

During my absence, a representative of the Doggie Nanny will be caring for my pet(s) and has
my permission to transport them to your facility for treatment. I authorize you to treat
my pet(s) and will be responsible for payment to you upon my return.

I give permission to Doggie Nanny Inc. to approve treatment up to $___________________. 

I will assume full responsibility upon my return for payment and/or reimbursement for veterinary
services rendered up to the above stated amount.

If the veterinary office named above is unavailable, or in the case of an emergency,
if the location is too far, I authorize Doggie Nanny Inc. to take my pet/s
to another veterinary office for treatment. I understand that Doggie Nanny Inc.
cannot be held responsible for the results of the veterinary treatment or the loss of my pet.
I also agree that Doggie Nanny Inc. is released from all liability related to any prior medical
condition my dog(s) had/has that would cause him /her to get easily injured or ill.

All medical information must be released to Doggie Nanny Inc. prior to my dog(s) arrival.
This agreement is valid starting on the date below whenever Doggie Nanny cares for my pets:

Owner's Signature: _________________________________Date: ____________________