Holiday Consent Form

Full Name *

Phone Number *

Address *

City *

Province *

Postal Code *

Email Address *

Pet(s) *

I will be absent on the date(s) stated *

During my absence my pet(s) will be under the care of *

Caregiver's Phone Number *

In an emergency I may be reached at *

If I am unable to be contacted in an emergency I have arranged for the caregiver to make any necessary decisions for my pet(s).

I hereby authorize Hillside Veterinary Hospital to perform all procedures as discussed or as deemed necessary by the attending veterinarian, and agree to pay all costs incurred.

Client Signature *

Today

Security Question *

I HAVE READ AND UNDERSTOOD THE PRIVACY POLICY *