Medical Power of Attorney


  • ... as my agent to make any and all healthcare decisions for my pet, except to the extent I state otherwise in this document. My agent shall follow my wishes as set forth through this document or other means. If my agent cannot determine the choice I would want for my pet, then my agent's decision shall be based upon what he or she believes to be in my pet's best interest. This medical power of attorney also takes effect if I become unable to make healthcare decisions for my pet and this fact is certified in writing.

  • I understand that this power of attorney revokes any prior medical power of appointment and shall exist indefinitely from the date I execute this document unless I establish a shorter time or revoke the power of attorney. If I am unable to make healthcare decisions for my pet and this power of attorney expires, the authority I have granted to my agent shall continue to exist until the time I am able again to make healthcare decisions for my pet.
  • If the person designated as my agent in unable or unwilling to make healthcare decisions for my pet, i designate the following alternative person to serve as my agent to make healthcare decisions for my pet as authorized by this document.

  • I hereby sign my name to this medical power of attorney.
  • Date Format: MM slash DD slash YYYY

CLIENT INFORMATION

  • PLEASE PRINT

  • Date Format: MM slash DD slash YYYY
  • Professional fees are to be paid at the time they are rendered.

  • ANIMAL INFORMATIONS

Avian History Form

  • This information will become a permanent part of your bird's medical record. Please take time to complete it as carefully as possible. THANK YOU!
  • Date Format: MM slash DD slash YYYY

BOARDING AGREEMENT

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • :

  • Pet(s) Boarding: (Estimated Cost)
  • VACCINATION POLICY


  • To insure the protection of all pets under our care, the following must be up-to-date:

  • If not up-to-date, or unable to provide proof of vaccination, I give permission to update my pet(s) vaccination in accordance with the above policy.

  • In addition, if any fleas/ticks are observed on you pet(s) while boarding, he/she (they) will receive treatment (Advantage or Frontline) at the owner's expense.

  • MEDICAL ILLNESS POLICY


  • One of the advantages of boarding your pet(s) at a veterinary hospital is that veterinary attention is readily available should the need arise. If your pet(s) becomes ill, we will call the emergency number(s) listed above regarding your pet's symptoms, treatment options and estimate of additional cost. If no one can be reached however, please indicate your wishes below should your pet(s) require treatment to relieve immediate discomfort or to resolve an important medical condition,

  • I have read and understand this agreement. I fully intend to pick up my pet(s) on the above-specified date. If circumstances change, I will notify the veterinarian of a new pick-up date.
  • (payment/picture ID required)
  • Date Format: MM slash DD slash YYYY

  • Special Instructions:

  • (Name of food)
  • Meds: :