Pet Emergency Contact Form

In case we are not able to get ahold of you during an emergency we need at least one Secondary Emergency Contact* other than yourself as well as your Preferred Emergency Veterinary Hospital** for your pet(s) to be taken to. If the selected Preferred Emergency Veterinary Hospital is not available to handle your pet’s emergency, the next closest emergency facility is where we would take your pet.

*Secondary and Third Emergency contacts cannot be yourself. We contact you first if there is an emergency, but if we cannot get a hold of you, we need at least one Secondary Emergency Contact who can make medical and financial decisions for your pet.

**Preferred Emergency Hospital needs to be a veterinary hospital that can handle emergency walk-ins. Many Primary Care Vets cannot facilitate emergencies.

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, Zip Code

Secondary: Phone *

Phone

Secondary: Email

Email

Third Emergency Contact

First

Last

Name

Third: Relationship

Relationship

Third: Address

Address, City, State, Zip Code

Third: Phone *

Phone

Secondary: Email

Email

Preferred Emergency Veterinary Hospital *

Hospital Name

Preferred ER: Address *

Address, City, State, Zip Code

Preferred ER: Phone *

Phone

Primary Veterinarian

Hospital Name

Primary Vet: Doctor Name

First

Last

Doctor Name

Primary Vet: Address

Address, City, State, Zip Code

Primary Vet: Phone

Phone

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

Submit

By submitting this form, you certify that the individuals listed above have the authority to make medical and financial decisions for your pet(s) in case of an emergency.