In-Home Pet Services - Veterinary Release Agreement
In the event that any of my pets or large animals appears to be ill, injured, or at significant risk of experiencing a medical problem at the start of service or while in the care of In-Home Pet Services, I give permission for In-Home Pet Services to seek veterinary service from a veterinarian or a veterinary clinic. Other veterinarians or emergency care clinics chosen by In-Home Pet Services are acceptable. I ask In-Home Pet Services to inform the attending clinic or veterinarian of my requested total diagnosis and treatment limit of $_____________ per pet / all pets (most common values are $200, $1000, or unlimited).
I understand that efforts will be made to contact me regarding any treatments, illness, injury, or potential problems as soon as the condition is deemed not life threatening and/or contact is possible. I understand that In-Home Pet Services provides hard work to prevent accidents and injuries, and that such problems may occur no matter how well a pet is cared for. I agree to allow In-Home Pet Services to use his best judgment in handling these situations, and I understand that In-Home Pet Services assume no responsibility for the actions and decisions of the veterinary staff, the health, or death of my pet(s).
I will assume full responsibility for the payment and/or reimbursement for any and all veterinary services rendered, including but not limited to diagnosis, treatment, grooming, medical supplies, and boarding. Such payments will be made within 14 days of the initial incident. I also agree to be responsible for all Special Service fees assessed by In-Home Pet Services for emergency transportation, care, supervision, or hiring of emergency caregivers, and will pay such fees within 14 days of each incident.
I also agree to be responsible for all Special Service fees assessed by "In Home Pet Services" for emergency transportation, care, supervision, or hiring of emergency caregivers, and will pay such fees within 14 days of each incident.
I further authorize In-Home Pet Services and my primary veterinarian(s) to share all of the medical records of all of my animals with veterinary clinics in an emergency in the interest of providing the best care for my ill or injured animal(s). Every dog, cat, and horse at the site of service will be current (per my veterinarians recommendations) on its rabies vaccinations prior to the arrival of any caregiver. I will also make arrangements to guarantee that each animal will remain current on its rabies vaccinations throughout each service visit period.
I agree to notify In-Home Pet Services of any signs of injury or possible illness before any visit as soon as the condition appears. In-Home Pet Services reserves the right to cancel service at any location where a pet with a potentially infectious condition exists. In-Home Pet Services strives to provide clean, safe service to each of our clients. In doing so, In-Home Pet Services strongly recommends that each pet and large animal be vaccinated, de wormed and protected from harmful insects according to veterinarian recommended standards. This agreement is valid from the date below and grants permission for future veterinary care without the need for additional authorization each time In-Home Pet Services cares for one or more of my pets. I understand that this agreement applies to all of the pets and large animals within In-Home Pet Services care. In signing this contract, I agree that I have the sole authority to make health, medical, and financial decisions regarding the animals that
will be scheduled to receive service.
Client Signature: _______________________________