I authorize my caregiver(s) to bring my pets to the Homer Veterinary Clinic for medical treatment while I am away. I understand that the veterinarians and caregiver(s) will do their best to try to reach me at the provided telephone number(s) in the event my pet must be seen. *

Agree

If I am not reachable, I grant consent to the veterinarians at the Homer Veterinary Clinic to act in the best interest of my pet and make emergency medical decisions as they best deem acceptable. *

Agree

I accept full financial responsibility for the medical care of my pets. *

Agree

In the event of my pet's death, I wish for one of the following options for my pet's remains: *

To be taken care of by the Homer Veterinary Clinic

To be returned to myself for burial.

To be cremated (with or without ashes returned). If this option is selected, my caregivers or I will need to make arrangements to transport my pet to Soldotna for these services.

Client/ Owner Name *

First Name

Last Name

Phone Number(s) I may be reached at while I am away

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(###)

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Authorized Caregivers Names and Telephone Numbers

First Name

Last Name

Phone

(###)

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First Name

Last Name

Phone

(###)

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Date *

MM

DD

YYYY