The undersigned Legal Owner of the animal named: _____________________ hereby authorizes
a licensed veterinarian, and whomever may be designated as assistants, to administer such
treatments and to perform such procedures as are considered therapeutically or diagnostically
necessary for the care of the animal including the administration of anesthesia.
In the event that emergency treatment is required, I authorize the veterinary staff and their
assistants to perform medical and surgical treatments necessary to preserve the life of my animal
until I can be contacted for further authorization.
I understand that no guarantee of successful treatment is made. I accept complete financial
responsibility for the treatment of the above named animal. I also understand that payment in full is
due upon release of my animal from the veterinary hospital or when service is otherwise
terminated. I understand that I am entitled to a written estimate and receipt of charges at my
request.
Veterinary services will be provided during nighttime hours as deemed necessary in emergency
situations. Continuous presence of qualified personnel may not be provided.
I certify that I have read and fully understand this authorization of emergency medical treatment,
the reasons why such treatment is considered necessary, as well as the advantages and possible
complications.
I hereby Release and Hold Harmless Brandy Alexander’s Inc., it’s staff and affiliates as well as
Watland Inc. from any claims arising out of any such emergency situations.
I certify that I have read and understand the terms and conditions of this agreement, and
acknowledge that this agreement shall be effective and binding upon all parties.
Brandy Alexander’s Inc.
DBA: Alexander’s Doggie Daycare, Resort & Grooming Spa
15412 S. 70th Court
Orland Park, IL 60462
708-535-woof (9663)
www.brandyalexanders.com
Authorization for Emergency Medical Treatment
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Signature of Owner: ___________________________________________Date: ___________________
Print Name _________________________________________________________________________
Signature of BAI Representative: _________________________________________________________