Busselton Vet TV: Pet Information

Holiday Contact and Treatment Consent Form

Please fill out the form below before your holiday drop-off.

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Holiday Contact and Treatment Consent Form

Before starting to complete the below form, we would like to take the opportunity to thank you for being organised and prepared for the unlikely event your pet needs treatment while you are away.

Please complete the details below to ensure every effort can be made to contact you in the event of an injury or medical emergency for your pet.

Name:(Required)

First Last

Address:

Street Address Address Line 2 City State Postcode

Email:(Required)

Pets Name(s):(Required)

Do any of your pets have any chronic health issues?

Yes

No

If yes, please list here.

Does your pet(s) require any regular medications?

Yes

No

If yes, please list here.

Date you are leaving:(Required)

Date you are returning:(Required)

Your contact details while you are away:

Who is the authorised person or kennel looking after your pet(s)?(Required)

Name

Phone(Required)

Email

In the event your pet(s) become severely unwell, or are injured in any way, and we are unable to contact you immediately, realising you will need to settle the account on collection of your pet(s) from the hospital, you consent to treatment and/or medical management up to the cost of:

Once again, thank you for being so prepared and organised. We hope not to see your pet while you are away (in the nicest possible way), however, if they do need to visit us we will do everything possible to help your pet(s).

Have a lovely time away!! 😊