Pet Sitter Authorization

West Seattle Animal Hospital

4700 42nd Avenue SW, Ste 210
Seattle, WA 98116

(206)932-3308

www.westseattleanimal.com

Owner Name (required)

First Name (required)	Last Name (required)

Owner Phone (required)
Phone Type	Phone Number (required)

Pet Sitter Name (required)

First Name (required)	Last Name (required)

Pet Sitter Phone (required)
Phone Type	Phone Number (required)

Second Pet Sitter Name

First Name	Last Name

Second Pet Sitter Phone
Phone Type	Phone Number

Consent
I authorize the West Seattle Animal Hospital to perform the recommended veterinary treatment(s) on my pet(s) at the discretion of the above mentioned pet sitter(s). The sitter(s) is to act as my agent(s) to make any decisions regarding treatment(s) that are best suited to my pet's condition, up to and including euthanasia if necessary, in the event that my pet should require medical treatment during my absence. I further authorize West Seattle Animal Hospital to give any information regarding care/treatment of my animal(s) to the sitter mentioned above.

Payment
I accept full responsibility for all charges incurred in the treatment of my pet and I agree to pay the fees for any veterinary services by leaving payment with my pet sitter(s) or by using a credit card number kept securely on file with The West Seattle Animal Hospital.

I authorize treatments costs of up to:

I have made arrangements with my pet sitter to pay and I will reimburse them accordingly.

I have made arrangements with your office for payment by credit card authorization on file.*

*If you haven't already done so, please contact our office to make arrangements to fill out a Credit
Card Authorization form.

Special Instructions

Signature
(I certify that I am the owner of the above mentioned pet and consent to all items on this form.)

I Agree
I Disagree

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Hours:

We are open five days a week

Mon - Fri

7:30 am - 7:00 pm

Closed 12:45PM to 1:45 PM

for lunch

Closed Weekends

Location:

Jefferson Square Office Building

West Seattle Animal Hospital
4700 42nd Avenue SW; Suite 210
Seattle, WA 98116
(206) 932-3308