Medical release
and credit card information
Grand Central Pet Station
Medical release form
Dear Client,
If GCPS deems that your dog is in need of immediate veterinary care, or if your dog presents with a potential illness, and we are unable to contact you , or you are unable to pick up your dog, we will take your dog to a liscensed veterinarian. If your personal veterinarian is located within our area, we will make every attempt to have your dog taken to them. If your vet is unavailable, or is out of our area, and your dog needs immediate
care, we will transport him to the best closest vet or to our personal vet.
I _______________________________,as owner or
Guardian of________________________ give permission to Grand Central Pet Station to act as my agent in the event of my dog needing medical attention. I further agree that I will be responsible for any and all cost of any veterinary care deemed nessesary by the liscensed veterinarian. In the event of a medical emergency, I authorize Grand Central Pet Station to have my dog treated by my vet or a vet of GCPS's choice. I will pay for or reimburse GCPS for all costs of care and treatment.
Owner
X________________________ Date___________
Cell Ph#__________________________________
Additional Ph#_____________________________
Regular Veterinarian_________________________
VetPh#____________________________________
