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Medical Authorization

To My Veterinarian and Authorized Caregivers

 

From: {AuthorizedBty:value}

You are receiving this authorization because you are either my veterinarian or an authorized caregiver in my absence.
 
I will not be available to provide care to my animals from {DepartureDate:value} to {ReturnDate:value}. I will be on a {TypeTrip:value} trip. {OutOfCountry:value}
 
During this time I am authorizing the following persons to provide care for {AbimalsBeingCaredFor:value};
 

{AuthorizedCaregiver1:label}

{AuthorizedCaregiver1:value}

{Phone1:label}: {Phone1:value}
{Caregiver1Email:label}: {Caregiver1Email:value}


{AuthorizedCaregiver2:label}

{AuthorizedCaregiver2:value}

{Phone2:label}: {Phone2:value}
{Caregiver2Email:label}: {Caregiver2Email:value}


{AuthorizedCaregiver3:label}

{AuthorizedCaregiver3:value}

{Phone3:label}: {Phone3:value}
{Caregiver3Email:label}: {Caregiver3Email:value}
 

{VeterinarianEmail:label}

{VeterinarianEmail:value}
 

{VeterinaryInstructions:label}

{VeterinaryInstructions:value}
 

{AuthorizedSpendingLimit:label}

{AuthorizedSpendingLimit:value}
 

My Contact Information

My Contact Phone Number while away is {OwnerContactPhone1:value}.
An alternate phone number for me while away is {OwnerContactPhone2:value}
My Email Address is:{MyEmail:value}
 
Thank you for your assistance while I am not available and thank you for caring for my animal(s).