Medical Release Form

Client Information
Name*
First Last
Phone*
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Pet Information
Description of Pet(s)*
Please list all available information about each pet. You may hit the + symbol next to the row to create another row if you have more than one pet.
Pet Name Breed Sex Weight Age Neutered/Spayed Additional Information
Consent and Release
In the event the pet or pets described herein should become ill or be injured and require veterinary care as the responsible party I, _____________________, hereby authorize Pets on Board Transport LLC to seek medical treatment from a licensed veterinarian. I will take full financial responsibility for all charges incurred. If Pets on Board Transport is unable to reach me, I authorize them to arrange for any emergency treatment deemed necessary for the well-being and health of the/my pet(s). My signature below acknowledges that I have read and understand this document, and I agree to hold Pets on Board Transport, LLC harmless from any illness or injury of my pet during or after transport of my pet.*
- I accept
Client Name*
First Last
Date*
YYYY dash MM dash DD
Phone
This field is for validation purposes and should be left unchanged.

Pet Name	Breed	Sex	Weight	Age	Neutered/Spayed	Additional Information

Client Information