Veterinary Release Form
Client Name: ___________________________________________________
Client Name: ___________________________________________________
Client Number:__________________________________________________
Address: _______________________________________________________
______________________________________________________________
Telephone Number 1 _____________________________________________
Telephone Number 2 _____________________________________________
TO WHOM IT MAY CONCERN
I hereby authorise the attending veterinarian to treat any of my pets as listed on the
Information sheet and I accept full responsibility for all fees and charges incurred in the
treatment of any of my pets. The Animal Carer is authorised to transport my pet(s) to and
from the veterinary clinic for treatment or to request "on-site" treatment if deemed necessary.
If I cannot be reached in case of an emergency, the Animal Carer on duty shall act on my
behalf to authorise any treatment including euthanasia in accordance with On The LeashLTD
terms and conditions and policies and procedures.
As the owner of the animal(s) in question, I hereby authorise On The Leash LTD to administer
any medication prescribed by the veterinarian treating my pet(s), and acknowledge that On
The Leash LTD staff have undergone a medication competency assessment, (which is not
formal training in administering medication to animals, as no staff member under On The
Leash LTD is trained in administering medication, as they are not trained veterinarians. This
assessment merely to state that as a third party they are competent to the best of their ability
to administer the prescribed medication to the animal(s) in question, and the prescribing
veterinarian is satisfied with the competency of the On The Leash LTD staff to administer this
medication as a third party, and a representative of the owner of the animal(s).) and will
administer the animal(s) medication, as instructed by the veterinarian, in accordance with On
The Leash LTD policies and procedures, and has passed the medication competency
assessment. On The Leash LTD is not liable for any reactions your animal(s) may sustain to any
prescribed medication by the prescribing veterinarian. On The Leash LTD is not liable for the
death of your animal(s), due to any reaction sustained by prescribed medication On The
Leash LTD staff is administering as a third party on your behalf. On The Leash LTD staff will
complete the AMAR Sheet every time medication is administered to you animal(s) on your
behalf. On The Leash LTD staff will keep daily diary’s and daily health check sheets, each time
you make an appointment with On The Leash LTD, On The Leash LTD will be permanently
monitoring your animal(s) health on these appointments, On The Leash LTD staff are NOT
trained veterinarians but will report any peculiarities that they notice to you, but it is your
responsibility as the owner of the animal(s) to report this to your veterinarian if you are
concerned by On The Leash LTD Staff’s reports.
Directors Signature on behalf of On The Leash LTD: __________________________________
Owner's Signature:___________________________________________________
Owner's Signature:___________________________________________________
Date: _____________________________________________________________
V1 12/13 RA
On The LeashLTD
© On The Leash LTD 2014