In the event of an emergency, car accident or death, what will happen to your pets? To help you make your wishes clear to your family and friends, consider filling out a form such as this and then give everyone a copy, including your pets’ veterinarian. Please discuss with your veterinarian the extent of care you wish for your pets to have and then set a cost limit. It is a good idea to give some type of credit card or deposit to your veterinarian so that any care may begin at once, even if you are incapacitated.
In Case Of Accidental Injury or Death
To Whom It May Concern:
In the event that I, ___________________________________________________, or my spouse, ______________________________________________________, am (are) incapacitated or killed and unable to make my wishes known regarding my dog(s), _______________________________________________________________________________________________________________________________________________________________________________________________________________________,
Please honor the following requests:
- ______________________________________________ is to be contacted as soon as possible at __________________________________________________ (day time phone) or _______________________________________ (night time phone) to care for my dog(s) until final arrangements can be made.
- If my primary contact person cannot be reached, please contact the following persons in the order listed until someone can take the dog(s). __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
- All expenses incurred by party assisting me for my dog(s) will be paid for by the above contacts who will be reimbursed by me, my spouse, my family or my estate.
- If my dog(s) are injured, I give permission to my contact people to take my dog(s) to the veterinarian for immediate care. My dog(s) veterinarian is: ____________________________________________________________________________________________________________________________________
- Present this form to my (or other) veterinarian to guarantee payment from me, my spouse, my family or my estate for any costs incurred while caring for my dog(s).
- If another veterinarian must be used, I prefer they contact my dog(s) veterinarian (listed above) regarding decisions on the dog(s) care and treatment.
- If my dog(s) are injured to the extent that they are in extreme pain and it is questionable if care will save them or if they are injured beyond any hope of recovery, I give my permission to humanely euthanize my dog(s) and cremate their remains.
- Photos and descriptions of my dog(s) are attached as well as health care information.
- If my dog(s) are missing from the vehicle, please contact the persons above to care for my dog(s) in my home. If it appears my dog(s) were in the vehicle and ran away, please try to find them and post a reward for them of a non-disclosed amount to be guaranteed by myself, my spouse, my family or my estate. My contacts will know how much to pay for the reward.
- The welfare of my dog(s) is my primary consideration. Please do all you can to insure my dog(s) comfort, safety and security.
Owner’s Name: ____________________________________________________________________
Address:____________________________________________________________________________________________________________________________________________________________________________________________________________________
Phone Daytime: ________________________________________________________
Phone Evening: ________________________________________________________
Phone Cell/Mobile: ____________________________________________________
Owner’s Signature: _____________________________________________________
Spouse’s Signature: ____________________________________________________
Date of Document: ___________________________________
Witnessed by: _________________________________________________________
