Authorization for Non-Owner to Consent in Millersville, MD - Noah's Ark Veterinary and Boarding Resort

Authorization for Non-Owner to Consent

If you have to send someone to bring your pet in to see us, we do need this form complete to be able to allow them to consent in your stead.

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

Pet's Name(Required)

First

Pet Information(Required)

Species Breed Color Age

Sex(Required)

Female

Male

Spayed/Neutered

Authorization for Non-Owner to Consent

I, the undersigned, hereby state that I am the legal owner, or legal representative, of the above listed pet and authorized to make all medical decisions regarding this pet. It is my desire to allow the below listed individual to consent to any and all financial/medical decisions for my pet. I acknowledge that this person will have the right to consent to medical treatment and I am financially responsible for all fees related to their approval of medical care.

Additional Verification

Due to the online nature of this form, you will also have to make contact with Noah's Ark via the phone number or e-mail listed on your account.

Authorized Individual's Name(Required)

First Last

Days Approved For(Required)

1 Day

2 Days

3 Days

Any additional days will require a new authorization form.

Signature(Required)