Pet Parent Name
I authorize the following individual(s) to make medical and financial decisions for care provided by Eastown Veterinary Clinic to the above-listed pet(s). I understand that I am fully responsible for all fees and charges that are due at the time of service. I also acknowledge that any medical care determined to be in the best interest of my pet by the attending veterinarians at Eastown Veterinary Clinic in my absence will be communicated directly to the following individuals in my absence.
Please Print Name