Consent Form | Mt. McKinley Animal Hospital

Our goal, as always, is to help your “best friend” live a long, happy, and healthy life.

Owner's Name(Required)

First

Last

Pet's Name(Required)

Date's of Absence

Contact information while away(Required)

Name of Caretaker(Required)

Phone(Required)

Email(Required)

Address (if different from owner)

Street Address

City

State

ZIP Code

Please select one(Required)

Caretaker will pay for any expenses related to the care of my pet(s).

Charge my credit card

Credit Card Number

Credit Card Expiration Date

Limit on Charges

Special Notes or Instructions

Consent

I authorize the above mentioned person(s) to seek medical care for my pet(s) while I am away.

Signature(Required)

Date(Required)

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