Your Name

Your Address

Your City, Your State, Your Zip

Your Home Phone Number

Your Work Phone Number

Your Cellular Phone Number

Your eMail address

Today’s Date

Dr.

Clinic

Address

City/State/Zip

Re: Medical Treatment Authorization

Dear :

Please accept this letter of authorization to perform any and all treatment you deem appropriate should my cats require medical treatment at any time I am not personally available to deliver them into your care.

I hereby authorize you to perform any and all necessary treatment in the event of a medical emergency and entrust you to personally make decisions pertaining to the welfare of my cat on my behalf at any time I am not available for consult. I also agree to authorize payment for services rendered associated with the care of my animals via the credit card I have on file with your practice.

Due to the fact that my cats are Hybrids and may require specialized treatment, I further authorize you to seek advice from other Veterinary professionals and to transfer treatment to another licensed veterinary specialist at your sole discretion. Additionally, payment for the services of any specialized veterinary care required should also be guaranteed using the credit card I have on file with you.

Lastly, if the determination is made to euthanize one of my cats, I authorize this only in the event that injuries are so extreme there is 0% chance for recovery. Prior to acting on this decision, I expect that every effort would be made to reach me via the contact numbers listed above.

Sincerely,

Your Name

CAK/ms