Creatures Pet Care of Kalamazoo, LLC (CPCK) requires all clients to complete a Veterinary Release Form. In the event of a medical emergency, CPCK will attempt to contact the client and emergency contact. In the event the neither can be reached, CPCK will seek to secure medical care for your pet(s). CPCK will attempt to have your pet seen at the veterinary clinic listed below, however, if your veterinarian is not available CPCK will bring your pet(s) to an appropriate clinic. * Please contact your veterinary clinic to find out what their policy is regarding providing medical care for your pet in your absence. * Please contact your veterinary clinic before you go out of town, to let them know that Creatures Pet Care of Kalamazoo will be caring for your pets in your absence. Client Name(Required) First Last Cell Phone #1(Required)Cell Phone #2(Required)Emergency Contact(Required) First Last Emergency Contact Number(Required)Veterinarian InformationName of Veterinary Clinic(Required) Clinic Phone Number(Required)Address of Veterinary Clinic(Required) Street Address City State / Province / Region ZIP / Postal Code Preferred Veterinarian(Required) Pet InformationName of Pet #1(Required) Type of Pet(Required) Age(Required) Medical History (don't forget to mention any medications your pet may be currently taking).Name of Pet #2 Type of Pet Age Medical History (don't forget to mention any medications your pet may be currently taking).Name of Pet #3 Type of Pet Age Medical History (don't forget to mention any medications your pet may be currently taking).Additional Information About My PetsClient Agrees To The Following In the event of a medical emergency, CPCK will attempt to contact the pet owner (client) and emergency contact. In the event the neither the client nor emergency contact can be reached, CPCK will seek to secure medical care for your pet(s). I understand that every effort will be made to take my pet to the preferred veterinary clinic, however, I authorize CPCK to seek treatment for my pet(s) at any appropriate clinic, if necessary. I authorize CPCK, my preferred veterinarian, and any other veterinary clinic involved in my pets care to share all medical records in an effort to provide the best care possible. I agree to assume full responsibility for payment of all veterinary services rendered. I understand that CPCK assumes no responsibility for the loss or injury of my pets, and is released from all liability related to transport, treatment and expenses. This agreement is valid from the date below, and grants permission for all future veterinary care without additional authorization each time CPCK cares for my pets.I give CPCK permission to approve treatment up to(Required) No Limit $250 $500 $1,000 Consent(Required) I agreeDate(Required) MM slash DD slash YYYY Signature
