(Scroll down for Animal Medical Center Veterinary Consent Form).
Local Veterinary Consent Form
Unless your local veterinarian is open 24/7, including Christmas, New Years Day, and other major holidays, both the Local Veterinary Consent Form and the Animal Medical Center Consent Form, below, should be  completed by clients before they bring their pets for boarding.”

Date _________

Veterinarian's Name _____________________________

Hospital Name _________________________

Address ______________________________

_____________________________________

Phone __________________

Fax ___________________

Dear Dr. _____________________

This letter is to confirm that Dr. Larry's Pet Sitting is authorized to bring our pet(s), named _____________________________ for care.

Check one:
( ) Our credit card information is already on file with you.
( ) Our credit card information is listed below.

Card Number_________________________
Expiration Date_____________________
Zip Code ___________________________ (Some veterinary establishments may ask for front and back xerox copies of your credit card).

Dr. Larry would prefer not to have access to a client’s credit card information. Such information would be given him only if a client has not had the time to convey it to AMC before his/her departure.

Our phone numbers during the time we are away from home is/are:
____________________________________________________

In the event of an emergency, we authorize the following expenditure:

Check one:
( ) Up to the amount of $______
( ) Whatever is necessary

We request you call us at the earliest possible time to discuss further treatment.

Sincerely,

___________________________________________
Signature as it appears on credit card

___________________________________________
Print name as it appears on credit card
 

Animal Medical Center
Veterinary Consent Form
(The preceding Local Veterinary Consent Form should also be filled out.)

Some local veterinarian close early several nights a week and some may not be available on weekends and holidays  For this reason, many clients set up contingency coverage at Animal Medical Center. AMC never closes.

AMC's policy requires that an owner pay 50% of the estimated bill before an animal is admitted, and the remainder when the animal is discharged.  Since it may not be possible for a pet sitter to lay out sums of money (the Emergency Room fee can run as high as $142), a form such as the following could be mailed or faxed to AMC and/or a copy given to Dr. Larry.

Mail:
Cashier Department
Animal Medical Center
510 E. 62nd Street
New York, NY 10021-8383
Phone:
212.838.8100
Fax:
212.752.2592

To Whom it May Concern:

This letter is to confirm that Dr. Larry's Pet Sitting is authorized to bring our pet(s), named _____________________________ for care.

In the event of an emergency, we authorize the following expenditure:

(  )  Up to the amount of $______
(  )  Whatever is necessary

Check one:
(  ) Our credit card information is already on file with you
(  ) Our credit card information is listed below

Card Number_________________________
Expiration Date_____________________
Zip Code ___________________________
(AMC clients must fax front and back xerox copies of their credit card).

Dr. Larry would prefer not to have access to a client’s credit card information. Such information would be given him only if a client has not had the time to convey it to AMC before his/her departure.

Our phone number(s) during the time that we are away from home, is/are:  _______________________________________________

We request you call us at the earliest possible time to discuss further treatment.

Sincerely,

_______________________________________
Signature as it appears on credit card
_______________________________________
Print name as it appears on credit card
_______________________________________
Case number, if your pet has already been a patient at AMC before