Client Treatment Authorization Form


Fill Out Your Form Online

You can easily fill out your Client Treatment Authorization Form online and submit it to us with the click of a button.



"*" indicates required fields

Pet Owner Information

Pet Owner's Name*
Alternate Contact:**
In the event I cannot be reached, the above-named person has my authority to make medical and financial decisions regarding my pet.

Pet Information

I give informed consent to Cypress Creek Animal Hospital to perform the discussed treatments and services while my pet is under their care.

My pet will also be examined for external parasites (fleas/ticks) upon their arrival and if any are found, he/she pet will be treated at my expense.

I agree to be responsible for any charges incurred while my pet is in the care of Cypress Creek Animal Hospital and that payment is due at the time of discharge from the hospital.

Note: A $300 deposit may be required for new patients or ill patients requiring treatment before they can be left in our care. If the actual cost of treatment is less than this amount, the remaining amount will be credited back to you upon pickup of your pet.
Signature of Owner/Agent**
This field is for validation purposes and should be left unchanged.