Authorization to Provide Care Form

Thank you for choosing Pro K9 Veterinarian in Richmond, Texas. Completing our authorization form allows our veterinary team to provide care for your pet and ensures we have your consent for treatment, procedures, and any necessary medical decisions.

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Complete Our Authorization to Provide Care Form

Please complete the form below prior to your appointment with Pro K9 Veterinarian. Providing accurate information and consent helps our veterinary team deliver safe, timely, and appropriate care for your pet while you are with us or in the event of an emergency.

Name *

First

Last

Email *

Phone

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Pet Name *

Treatment Authorization *

I authorize Pro K9 Veterinarian to examine, diagnose, and treat my pet(s). I understand that veterinary care may include diagnostic tests, medications, and medical or surgical procedures deemed necessary for my pet’s health.

Surgical Procedures *

I authorize Pro K9 Veterinarian to perform any necessary surgical or procedural interventions, including the use of anesthesia, as required for the health and well-being of my pet(s).

Emergency Situations *

If an emergency occurs and I cannot be reached, I authorize the Clinic to use its best judgment in providing urgent care or life-saving treatment for my pet(s). I accept financial responsibility for such care.

Vaccinations and Treatments *

I acknowledge that vaccinations and treatments carry inherent risks. While Pro K9 Veterinarian takes all reasonable precautions, I understand and accept that the Clinic and its providers cannot guarantee how my pet(s) will respond to any vaccine, medication, or treatment.

Transfer of Records Consent *

I authorize Pro K9 Veterinarian to transfer and make available all medical records for the patient listed above to another provider within Pro K9 Veterinarian, if my original provider is unavailable or no longer affiliated with the facility.

Financial Responsibility *

I am financially responsible for all services provided to my pet(s) at the Clinic. I agree to pay in full at the time of service unless a prior arrangement has been made. I understand that failure to pay may result in additional fees or collections action.

Contact Information Agreement *

I agree to provide accurate, current contact information and ensure I am reachable during my pet’s stay or treatment. I will update the Clinic if my contact details change.

Media Authorization *

I consent to and authorize Pro K9 Veterinarian to use photographs, video, voice recordings, or other media taken of me solely for clinical educational purposes.

By signing, I acknowledge that I have read, understood, and agree to the terms above. *

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Today's Date *

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Authorization to Provide Care Form

Complete Our Authorization to Provide Care Form

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