Pet Emergency Contact Form

In case we cannot reach you during an emergency, we need:

• A Secondary Emergency Contact* (someone other than yourself)
• A Third Emergency Contact* (optional, but recommended)
• Your Preferred Emergency Veterinary Hospital** for your pet(s)
• Your pet(s) Primary Veterinarian (optional, but recommended)

⚠️ Important: The Owner/Primary Emergency Contact section must include your own information for identification purposes. If your information is not included, we may not be able to locate your form in an emergency.

*Secondary and Third Emergency contacts cannot be yourself. These contacts must be able to make medical and financial decisions for your pet if you are unreachable.

**Preferred Emergency Hospital must be able to handle emergency walk-ins. Many primary care vets cannot provide emergency care. If your chosen Preferred Emergency Veterinary Hospital is unavailable, your pet will be taken to the next closest emergency facility.

Pet Name(s) *

Owner/Primary Emergency Contact *

First

Last

Name

Owner/Primary: Phone *

Phone

Owner/Primary: Email

Email

Secondary Emergency Contact *

First

Last

Name

Secondary: Relationship *

Relationship

Secondary: Address

Address, City, State, Postal Code

Secondary: Phone *

Phone

Secondary: Email

Email

Third Emergency Contact

First

Last

Name

Third: Relationship

Relationship

Third: Address

Address, City, State, Postal Code

Third: Phone

Phone

Third: Email

Email

Preferred Emergency Veterinary Hospital *

Hospital Name

Preferred ER: Address *

Address, City, State, Postal Code

Preferred ER: Phone *

Phone

Primary Veterinarian

Hospital Name

Primary Vet: Doctor Name

First

Last

Doctor Name

Primary Vet: Address

Address, City, State, Postal Code

Primary Vet: Phone

Phone

Known Allergies, Chronic Conditions, Diseases, Special Needs, Medications, or Medically Pertinent Information

Authorization Confirmation *

• I confirm that the individuals listed above are authorized to make medical and financial decisions for my pet(s) in the event of an emergency.

Submit