Skip to content
Online Refill Request
GET DIRECTIONS
11876 SW Beaverton Hillsdale Hwy, Beaverton, OR 97005
503-646-6101
About
Our Team
FAQs
Hospital Updates
New Clients
Our Patients
Services
Preventive Care
Urgent Care
Online Store
Testimonials
Pet Health
Pet Insurance
Pet Health Online Library
Blog
Contact Us
Online Forms
Careers
Emergency
Make An Appointment
Home
»
Authorization To Treat
Authorization To Treat
I hereby authorize Beaverton Pet Clinic to make medical and health care decisions for my pet(s) (listed below) in my absence. In the event of an emergency, I understand that Beaverton Pet Clinic (BPC) will attempt to contact me at the phone number(s) provided; however, I understand that if I cannot be reached within a reasonable amount of time (as determined by BPC based on urgency of medical care), I authorize BPC to treat my pet however is deemed necessary for its health and well-being. Furthermore, I agree to pay for any and all expenses that may be incurred.
(Required)
I have read and authorize
Pets included in authorization (please note any special medical concerns):
(Required)
Dates this Authorization is valid (or indicate if this authorization is ongoing):
(Required)
Phone number(s) to contact owner(s):
(Required)
Name of person(s) authorized to make medical decisions:
(Required)
Phone number(s) of person(s) authorized to make medical decisions:
(Required)
In the unlikely event that your pet is facing an urgent and immediate life-threatening condition, we will do everything in our power to ensure his or her continued comfort. If your wishes are a humane end to their suffering, please initial below.
Yes, if the doctor feels that recovery is not possible.
No, please keep my pet comfortable until I return.
Digital Signature (Name)
(Required)
First
Last
Email
(Required)
Today's Date
MM slash DD slash YYYY
CAPTCHA
Make Appointment
Services
Pet Records
Meet the Team
What's Next
1
Call us or schedule an appointment online.
2
Meet with a doctor for an initial exam.
3
Put a plan together for your pet.
Make An Appointment
×