Cedarbrook Veterinary Care Absence Consent Form

Cedarbrook Veterinary Care Absence Consent Form
In the event of a medical emergency involving my horse(s), every effort should be made to contact me regarding my horse’s current situation.

To facilitate this I have left a copy of phone numbers where I can be reached throughout my absence as well as the length of stay with both the people watching my horse(s) as well my veterinarian.

If, however, decisions need to be made and/or procedures need to be performed in my absence, please use this form as a guideline.

As the owner of the horse(s) listed below I do give my permission to Cedarbrook Veterinary Care, to perform services on the horses listed below in my absence.
Registered Name Nick Name Brief Description
which is/are stabled at:
Name of Facility:
Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Contact Person at Facility:
Phone at Facility:

Area Code Phone Number
If the emergency is more severe, the veterinarians at Cedarbrook Veterinary Care may use their best judgement in determining if my horse can be saved within a reasonable medical probability and financial practicality with a cost cap of $:
I agree to assume full financial responsibility for these services.

If the veterinarians at Cedarbrook Veterinary Care determine that my horse cannot be saved due to the severity of the condition and/or financial constraints, I hereby authorize them to euthanize my horse(s) for humane reasons.
Any additional comments:
Dated this day

Month Day Year
Date
Printed Name of Owner Signature of Owner

Clear
Phone Number of Owner

Area Code Phone Number
Email of Owner
example@example.com
Should be Empty: