Print (ctrl + P) and fill out
LETTER OF AUTHORIZATION
LETTER OF AUTHORIZATION
Date:
To (Name of Vet):________________________________________
I the undersigned, hereby authorize _____________________________________ to act on on my behalf
(Please print name)
in all manners relating to ___________________________care and treatment, including signing of all
(Pet’s name)
documents relating to these matters. Any and all acts carried out by ________________________on my
(Please print name)
behalf shall have the same affect as acts of my own.
This authorization is valid until further written notice to (Name of Vet)_________________________________________________
Sincerely,
_______________________________________ ___________________________________
Owner/Client Signature Date
