In the event of a medical emergency involving my animal (s), every effort should be made to contact me regarding my pet’s current situation. To facilitate, here are the phone numbers where I can be reached throughout my vacation/leave, as well as the people watching my animal (s).
If, however, decisions need to be made or procedures need to be performed in my absence, please use this form as a guideline.
(Please include registered names and nick names)
who are boarded at
do give my permission for the veterinarians of Adobe Veterinary Center to perform services on the above named animals in my absence.
I agree to assume full financial responsibility for these services.
is insured is not insured.
If yes, it is under the following type (s) of insurance:
Mortality Surgical Major Medical
Contact name and telephone number:
Policy requirements on when to contact the insurance company:
would not want my animal referred to a secondary facility for emergency treatment or surgery if the doctors at Adobe Veterinary Center, in their professional opinion, conclude that my animal may benefit from this emergency referral. If emergency referral surgery is needed, I understand the following:
1. Emergency equine colic surgery and uncomplicated follow-up can range from $8,000.00 to $15,000.00.
2. Different secondary facilities have different monetary requirements upon admission, and I have made provisions with my animal’s sitter to provide for these requirements.
4. My insurance company
does does not require that surgery be attempted.
If the doctors of Adobe Veterinary Center or the secondary facility determine that my animal can not be saved due to the severity of the condition and /or financial constraints, I hereby authorize them to euthanize my animal for humane reasons.