Authorization To Treat Form | Beaverton Pet Clinic

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

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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 Appointment

Authorization To Treat

What's Next

Call us or schedule an appointment online.

Meet with a doctor for an initial exam.

Put a plan together for your pet.

Where family pets find loving care

Beaverton Pet Clinic

Emergencies