Release for emergency treatment

Emergency treatment authorization

Emergency Treatment Authorization

Date

Release for Emergency Medical Treatment 2022 EMERGENCY MEDICAL TREATMENT AUTHORIZATION FORMThis form grants temporary authority to US Logistic Carriers to provide and arrange for medi- cal care for a pet in the event of an emergency, where the pet is not accompanied by it’s owner, and it may not be feasible or practical to contact them. This form should accompany the pet in the event of off-site trips or emergency relocation of the pet(s).

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Address

Pets Date of Birth

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Please note all conditions for which the pet is currently receiving treatment: Note any other significant medical information: AUTHORIZATION AND CON-SENT OF OWNER(S) OR LEGAL GUARDIAN(S) I do hereby state that I have legal rights of the aforementioned pet(s).

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Primary Veterinarians Name:

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Phone

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Consent

By checking this box I grant my authorization and consent for _________________________________________ (hereafter “Designated Pet Transporter”) to administer general first aid treatment for any minor or major injuries or illnesses experienced during transit. If the injury or illness is life threatening or in need of emergency treatment, I authorize the Designated Adult to summon any and all professional emergency personnel to attend, transport, and treat the pet(s) and to issue consent for any X-ray, anesthetic, blood transfusion, medication, or other medical diagnosis, treatment, or animal hospital care deemed advisable by, and to be rendered under the general supervision of, any licensed physician, veterinary, animal hospital, or other medical professional or institution duly licensed to practice in the state in which such treatment is to occur. I agree to assume financial responsibility for all expenses of such care. It is understood that this authorization is given in advance of any such medical treat- meant, but is given to provide authority and power on the part of the Designated Pet Transporter in the exercise of his or her best judgment upon the advice of any such medical or emergency personnel.

Dogs

Cats

Cargo

Release for emergency treatment

Emergency treatment authorization

Emergency treatment authorization

Emergency Treatment Authorization

Title

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