Arden Animal Hospital

1823 Fulton Avenue
Sacramento, CA 95825

(916)485-5412

ardenanimalhospital.com

Pet Caretaker Release Form Form

Date that this agreement is valid: (required) :
Please list who has been contacted to care for your pet in your absence: (required)

Important, please read:
The person above has been contacted to care for my pet in my absence and has my permission to place my pet in your care in case of an emergency. I understand that attempts to contact me will be made as soon as medical care is deemed necessary, however, in the event that I cannot be reached immediately, I ask the person above to inform the attending clinic or veterinarian of my requested total diagnosis and my treatment limit of (dollar amount provided below). I trust that the efforts will be made to contact me regarding any treatments, illness, injury or potential problems as soon as the condition is deemed non-life threatening or as soon as I become available.
Total diagnosis and treatment limit (dollar amount) (required)

Important, please read:
I understand that the person I've listed above cannot be held responsible for the costs of results of the veterinary treatment or the loss of my pet and I will assume full responsibility for the payment and/or reimbursement for any and all veterinary services rendered, including but not limited to: diagnosis, treatment, grooming, medical supplies and boarding.
Pet's Name (required)

Pet Description (Color/Breed/Sex) (required)

Pet's Age (required)

Medical Conditions/Medications

If my pet becomes ill/injured/appears to be at significant risk, I request that they be taken to: (required)
Arden Animal Hospital
Sacramento Veterinary Referral Center
Neither


If none of the above work, I authorize my pet be taken to another office for treatment (required)
Yes
No


Emergency Contact Name/Numbers: (required)


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