Pet Emergency Care Form

We will have this form available for a signature when we pick up your pet(s).

EXPRESS PET MOVERS
2701 Elmwood Dr., Bryan,
Texas 77802
(979) 589-1744
AUTHORIZATION FOR EMERGENCY CARE

Client’s Name:_________________________________________________________

Address:_______________________________________________________________

Phone #:______________________________ Phone # 2:_____________________

Description of pet(s):____________________________________________________________________________________________________________________________________________________________________________________

Pet’s Name(s):_______________________________________________________

In the event the above described pet(s) should become ill or injured and should require veterinary care, I, __________________________, as the responsible party, do authorize EXPRESS PET MOVERS to take the pet(s) to a licensed veterinarian for treatment. I will take full financial responsibility for all bills incurred not to exceed $_________________________.

If EXPRESS PET MOVERS is unable to reach me, I authorize them to make any emergency decision they deem necessary for the well being of the pet(s).

By signing below, I certify that I have read and understand this document. I agree to hold EXPRESS PET MOVERS harmless for any illness or injury of my pet incurred during or after the transport of my pet.

Client Name:_________________________________ Date:____________________
(Signature)

We will have this form available for a signature when we pick up your pet(s).

CLIENT INFORMATION

 

PET INFORMATION

 

Agreement

  • In the event the above described pet(s) should become ill or injured and should require veterinary care, the client, as the responsible party, does authorize EXPRESS PET MOVERS to take the pet(s) to a licensed veterinarian for treatment. The client will take full financial responsibility for all bills incurred.
  • By clicking SUBMIT below, the client certifies that they have read and understand this information. the client furthermore agrees to hold EXPRESS PET MOVERS harmless for any illness or injury of my pet incurred during or after the transport of my pet.
  • If EXPRESS PET MOVERS is unable to reach me, the client authorizes them to make any emergency decision they deem necessary for the well being of the pet(s).
 

ADDITIONAL INFORMATION