Name

First Name

Last Name

Cell Phone

(###)

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Work Phone

(###)

###

####

Home Phone

(###)

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Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Veterinarian Name

Veterinarian's Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Veterinarian's Phone

VETERINARIAN AUTHORIZATION: During my various absences, Brienna Boisvert of Expawditions LLC, will be caring for my animal (s). She has my permission to transport them to and from your office as deemed necessary. I authorize you to treat my animal (s) and I will be fully responsible for all fees and charges and will pay for all charges they incur on my behalf upon my return. I further authorize you to give out any information about my animal (s) to Brienna Boisvert of Expawditions LLC.

I have read, understand, and agree with the above statement.

URGENT VETERINARY TREATMENT AUTHORIZATION: This form will be retained on file and will be used to authorize urgent veterinary treatment in the event your pet (s) require such treatment during your absence and we are unable to contact you at the time. Should you change vets it is the clients responsibility to inform Brienna Boisvert and Expawditions LLC before service dates.

I have read, understand, and agree with the above statement.

To whom it may concern: I have contracted for services from Expawditions LLC during my absence and I authorize Expawditions LLC to act on my behalf to request veterinary treatment and service when they deem it necessary. I accept full responsibility for charges incurred in the treatment of my pet (s), not to exceed the following amount for each pet.

I authorize Expawditions LLC to act on my behalf.

Pets Name, Description, and Maximum Veterinary Amount Authorized.

If multiple pets require treatment, do not exceed a combined total of:

Expawditions LLC reserves the right to utilize the services of any available veterinary clinic. If time permits we will attempt to use your primary veterinary clinic. If it is not practical to do so, Expawditions LLC will use the best available option.

I have read, understand, and agree with the above statement.

Preferred URGENT Veterinary Care Clinic

Preferred URGENT Veterinary Care Clinic Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Preferred URGENT Veterinary Care Clinic

(###)

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I authorize you to treat my animal (s) and I will be fully responsible for all fees and charges and will pay for all charges incurred on my behalf, immediately upon my return.

I have read, understand, and agree with the above statement.

Name on Card

Number on Card

Expiration Date

CCV Code

Type of Card

Maximum Charges Authorized

Client Signature

Date

YYYY