Regular Veterinarian_____________________________________________________________________________

Pets Name/Names______________________________________________________________________________

In my absence, T Wheat's Paw-2-Purr-Fect Pet & House Sitting Service will be caring for my animal(s). T Wheat's Paw-2-Purr-Fect Pet & House Sitting Service has my permission to transport them to and from your office or, in the case of large animals, request "on site" treatment from your office as is deemed necessary. I authorize you to treat my animal(s) and I will be fully responsible for all fees and charges incurred on my pet(s) behalf when I return. I further authorize you to give out any necessary information about my animal(s) to Tracey Wheat, the owner of T Wheat's Paw-2-Purr-Fect Pet & House Sitting Service

Client Signature_______________________________________________________________________

This form will be retained on file and will be used to authorize urgent veterinary treatment in the event that your pet(s) require such treatment during your absence and we are unable to contact you at the time. Should you change Vets please notify T Wheat's Paw-2-Purr-Fect Pet & House Sitting Service before service dates.

Client Name:_________________________________________________________________________

Address:____________________________________________________________________________

City: ____________________________________________________________ZIP:________________

Home Telephone: __________________Work Telephone: ______________Mobile: ________________

Primary (other) Emergency Contact: _____________________________________________________________

Alternate Emergency Contact:__________________________________________________________________

To whom it may concern: I have contracted for services from T Wheat's Paw-2-Purr-Fect Pet & House Sitting Service during my absence and I authorize T Wheat's Paw-2-Purr-Fect Pet & House Sitting Service to act on my behalf to request veterinary treatment and services when they deem it necessary. I accept full responsibility for charges incurred in the treatment of my pet(s), not to exceed the following amounts for each pet:

_____________________________________________________________________$_____________

_____________________________________________________________________$_____________

If multiple pets require treatment, do not exceed a combined total of $_________________.

T Wheat's Paw-2-Purr-Fect Pet & House Sitting Service reserves the right to utilize the services of any available veterinary clinic. If time permits, we will attempt to utilize your primary veterinary clinic. If it is not practical to do so, T Wheat's Paw-2-Purr-Fect Pet & House Sitting Service is authorized to utilize an alternative Veterinarian or Emergency Facility and in the case of larger animals, may find it necessary to utilize an animal ambulance service to transport animals to the veterinary clinic. In the unlikely event that a pet has passed on, T Wheat's Paw-2-Purr-Fect Pet & House Sitting Service is authorized to transport the pet to the veterinary clinic to be held under refrigeration until owner can be contacted regarding disposition.

If you have an account with your Veterinarian please list account number or any information I would need to have account accessed.

Do you have an account? Yes____ No____ Account # _______________________________________

Additional information:

___________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

I authorize you to treat my animal(s) and I will be fully responsible for all fees and charges and will pay for all charges that are incurred on my behalf, immediately upon my return. Credit Card to use if I cannot be reached: Name_________________________________ Type Card:_______________________________

#____________________________________ Billing Zip Code:: __________________________________

Expiration: ____________________________ Max. Charge Authorized____________________________

Authorized charges to this card are for Emergency Veterinarian Services/Pet Medications ONLY.

Client Name______________________________________

Client Signature________________________________________ Date__________________