Buxmont Veterinary Hospital Absent Owner Treatment Consent Form

To be filled out by the owner and used in case their pet(s) need medical/emergency care while at Town & Country Pet Care Center.

Owner's Name(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email(Required)

Emergency Contact(Required)

Dates my pet(s) are at Town & Country Pet Care Center

Name of pet(s) and brief description of any medical conditions:

Please choose one of the following(Required)

I authorize Buxmont Veterinary Hospital to examine my pet if care is needed.

I DO NOT authorize Buxmont Veterinary Hospital to examine my pet if care is needed.

Please choose one of the following(Required)

Buxmont Veterinary Hospital will attempt to reach me and/or my emergency contact by phone. If I cannot be reached, I decline any/all veterinary services.

Buxmont Veterinary Hospital will attempt to reach me and/or my emergency contact by phone. If I cannot be reached, I authorize up to $500 towards veterinary services to be charged by Buxmont Veterinary Hospital to the credit card on file at Town & Country and understand that I am fully responsible for payment.

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Buxmont Veterinary Hospital Absent Owner Treatment Consent Form

Enjoy a FREE Bandana and Fun Scent with all Grooming Services!

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