( GA GWT JW 12/7/19 evsanalytics6 )Bighorn Veterinary Service in Pine, CO - Absentee Authorization Form

Bighorn Veterinary Service

13545 US Highway 285
Pine, CO 80470



Absentee Authorization Form

I authorize the doctors of Bighorn Veterinary Service, LLC, to care for the listed animal(s) in my absence. Reasonable efforts will be made to contact me at the listed numbers and email address. I authorize the listed agent to make medical decisions in my absence.  In the event that I, or my agent, cannot be reached, I authorize Bighorn Veterinary Service to make medical decisions for the welfare of my pet including, but not limited to, hospitalization, medical treatments, and surgery. In the rare event that a medical condition arises that would result in loss of quality of life, such as permanent medical damage with little or no chance of future normality or severe suffering, I authorize the doctors of Bighorn Veterinary Service to euthanize my pet after making thorough efforts to contact myself or my agent. 

I understand that the outcome cannot be guaranteed and agree to the above care without recourse. Furthermore I agree to be financially responsible for any charges incurred in my absence up to the dollar amount listed below, and agree to pay the expenses in full upon my return. By submitting this form, I agree to be bound by the above statements.

Absentee Authorization Form

Name (required)
First Name (required)
Last Name (required)
Address (required)
Street Address (required)
City (required)
State / Province (required)
Zip / Postal Code (required)
Authorization date beginning: (required) :
Authorization date ending: (required) :
Animal's Name(s) (required)

Phone (required)
Phone TypePhone Number (required)
E-Mail Address (required) :
Additional Phone
Phone TypePhone Number
Additional Phone
Phone TypePhone Number
In the event I cannot be reached, please contact:
First Name
Last Name
Phone TypePhone Number
I agree to absentee authorization for professional services
up to the listed dollar amount below: (required)

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