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11876 SW Beaverton Hillsdale Hwy, Beaverton, OR 97005
503-646-6101
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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
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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.
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