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Vacation Consent Form

In the event of a medical emergency involving my horse(s), every effort should be made to contact me regarding my horse’s current situation.

To facilitate this I have left a copy of phone numbers where I can be reached throughout my vacation / leave as well as the length of stay with both the people watching my horse(s) as well my veterinarian.

If, however, decisions need to be made procedures need to be performed in my absence, please use this form as a guideline.

I

,

as the owner of the horse(s) (please include both registered names and nick names)

which are stabled at

do give my permission to Christi Garfinkel DVM, to perform services on the above named horses in my absence.

If the emergency is more severe, Dr. Garfinkel may use her best judgement in determining if my horse can be saved within a reasonable medical probability and financial practicality with a cost cap of

.

I agree to assume full financial responsibility for these services.

If Christi Garfinkel DVM determine that my horse can not be saved due to the severity of the condition and/or financial constraints, I hereby authorize them to euthanize my horse for humane reasons.

Any additional comments:

Signature of Owner

Date

If you would like to receive an email of the completed form, please enter your email here:


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