Authorized Agent Form
(Circle C.)

Please fill out the authorized agent form below, and a member of our team will get back to you shortly. We look forward to hearing from you! Please keep in mind that this form is for our South Lamar location.

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Authorized Agent Form

Thank you for considering Bluebonnet Animal Hospital for your pet’s needs. Please fill out the below form below in its entirety to ensure we can provide you and your pet with the best possible care.

Please Note: Any fields with * are required.

I state that the individual listed below is:

  • 18 years of age and above.
  • Authorized to make medical decisions, including emergency medical treatment, necessary anesthetic procedures, and in rare cases humane euthanasia (if primary owner is unable to be reached).
  • Authorized to pay for any services rendered as an authorized agent.
  • Authorized to receive medical records for treatment and wellness visits.

I approve this individual to make decisions for all of my pets (if the individual is only approved to make decisions for individual pets, please state this below).

Clear Signature