Consent of Treatment Form

Please fill out the form below, and a member of our team will get back to you as soon as possible if we have any questions. All fields marked with * are required.

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I hereby authorize the following people to present my pet(s) for treatment in my absence should an injury or illness occur to my pet(s) that requires veterinary care. I will provide the following people with a method of payment (Cash, Check, or Credit Card (Visa, Mastercard, and Discover) to pay the bill at the time of service. *

Print Name

This includes any medical treatments, anesthesia consents, or surgical procedures, and to sign for charges; with fees: not to exceed $

I authorize any veterinarian to provide my pet with veterinary care and essential medical service. Do you authorize intensive medical efforts for your pet? *

Yes
No

In the event the attending veterinarian determines that my pet is suffering and/or is incurably injured, do you give your consent for euthanasia? Please understand that if your pet’s health is this critical, we will try everything in our power to get in contact with you before any decisions are made. *

Yes
No

I will be able to be reached at the following phone number: *

Pet Caretaker #1 *

First

Last

Phone *

I consent to receive SMS text messages from Whatcom Veterinary Hospital. Msg & data rates may apply. Reply STOP to opt-out. *

Yes
No

Email *

Signature *

Clear Signature

Pet Caretaker #2

First

Last

Phone

Signature

Clear Signature

Date *

Date of Departure

Return Date

Consent of Treatment

Consent of Treatment Form

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