Emergency Form

Pet Emergency Information PLACE CURRENT PHOTO HERE

Pet’s Name/Breed: _______________________________ Color/Markings: _________________________________ DOB/Height/Weight: _____________________________ Vaccine Exp. Dates: ______________________________

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Known Medical Issues: ___________________________ Sig. Personality Traits: ____________________________

Owner Name & Address: My Regular Veterinarian Is: ___________________________________ _____________________________________________________ ___________________________________ _____________________________________________________ My pet is insured with: ________________________ ___________________________________ In the event of an emergency where I am unable to attend to my animal, Phone Numbers: ___________________________________ please contact the authorized agent(s) listed on this form. If unable to reach an authorized agent, please take my pet to the nearest veterinarian or ___________________________________ professional boarding facility for safe keeping until an agent can be Authorized Agents Name/Phone#: reached. Owner and/or authorized agents gaurantee all expenses. Thank ___________________________________

you for looking after my pet!

___________________________________ Signed: ___________________________________ Date: _____________ These people are fully authorized to care for my animals in my absence.