Davis Pet Hotel & SpaLimited Power of Attorney for Pet Emergency Care Name * First Name Last Name Email Address * Pet Name I appoint Davis Pet Hotel & Spa, a division of Davis Animal Hospital, as my attorney-in-fact, to do all that is necessary or desirable for maintaining the health of my pet listed above, specifically, to approve and authorize any and all medical treatment deemed necessary by a duly licensed veterinarian and to execute any consent, release or waiver of liability required by veterinary authorities incident to the provision of medical, surgical or other essential care to my pet by qualified veterinary medical personnel. This document is good for the year of 2020 * I agree I disagree Davis Pet Hotel & Spa may authorize, without approval from me, veterinary services up to and including the amount listed below. Any amounts over and above that will require that a concierge or the veterinarian to contact me by phone at the emergency contacts I will provide for discussion and approval. * Enter amount NOT to exceed. $ I understand that if I am not able to be contacted for verbal or written approval, that treatment will not exceed the amount authorized above. * I understand I do not understand Based on the emergent nature of need, my pet will be treated by a veterinarian on staff at Davis Animal Hospital or transported to the Veterinary Emergency Referral Center if after veterinary office hours. * I understand I do not understand I am responsible for all charges incurred at Davis Animal Hospital and/or the Veterinary Emergency Referral Center. * I understand I do not understand In the unlikely event of a cardiac or respiratory arrest, we will do all we can to resuscitate your pet. I understand that I am responsible for any additional costs related to this event. * Please resuscitate my pet. I will pay any additional charges this may incur. Do not resuscitate my pet. Emergency Contacts Emergency Contact 1 * First Name Last Name Relationship to Owner * This contact can make medical decisions for my pet on my behalf. * Yes No Phone * (###) ### #### Emergency Contact 2 First Name Last Name Relationship to Owner This contact can make medical decisions for my pet on my behalf. Yes No Phone (###) ### #### Emergency Contact 3 First Name Last Name Relationship to Owner This contact can make medical decisions for my pet on my behalf. Yes No Phone (###) ### #### Thank you!We have received your form and will have you sign it when you check in.Click HERE to return to the Forms/FAQ page.
