Name: Eastside Veterinary Associates
Address: 8934 122nd ave NE, Kirkland, WA, 98033, US
Telephone: 425-882-7788
Price range: $$

Please choose a location*
- Kirkland
- Newcastle/Renton
Today’s Date*
Legal owner of pet*
First Last
Name of pet(s)*
I authorize (including phone number)*
Name of pet sitter, caretaker, family member, etc.
To care for and make decisions regarding medical care for the pet(s) listed above*
- for the period of time
- indefinitely, for the remainder of the pet’s life
Fill in dates*
I understand that services may include examination of my pet, medications, and diagnostic or surgical procedures and that I may be required to provide a credit card deposit upon admission of my pet to the hospital. I authorize the doctors and staff of Eastside Veterinary Associates in an emergency situation, to follow through with such procedures as are necessary for the well being of my pet on a continuing basis until further communication with me. I agree to assume financial responsibility for all routine and emergency services rendered.
Signature of legal owner*
First Last
Owner’s Emergency contact phone number and/or email*

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