We offer same day sick appointments Monday through Friday. New clients save $40 off. Call our office at (757)340-3913 to schedule today!

Care Authorization Form

Bay Beach Veterinary Care Authorization Forms

Please use our online form below or download our printable PDF to complete your Care Authorization for Bay Beach Veterinary Hospital.

Bay Beach Veterinary Care Authorization Online Form

This form has been designed to provide you, the pet owner, with the ultimate peace of mind that your pet care provider has all of the information needed in order to treat your pet in the event of an emergency while you are away. This form is to be completed and retained by our hospital so that we have access to the information should the need arise. Please read and completely fill out the form below and click the Submit button.

If you prefer to download a PDF form and print it out to fill in at your convenience, please see the PDF link above.

Owner's Information

Owners(s) Name(s): *

Address: *

City: *

State: *

Zip: *

Primary Phone #: *

Emergency Phone #: *

Pet Sitter / Authorized Care Giver's Information (if applicable)

Care Giver(s) Name(s): *

Care Giver Address: *

CG City: *

CG State: *

CG Zip: *

Care Giver Primary Phone #: *

Care Giver Emergency Phone #: *

Pet Insurance Information (if applicable)

Company: *

Policy #: *

Fill out the blanks in the certification below as applicable. *

Credit Card Information

Card Holder's Name (As appears on card): *

Card Type: *

Card Number *

CV Code: *

Zip Code: *

Exp. Date: *

Credit Card Authorization *

Owner's name *

This contract is to be retained only by Bay Beach Veterinary Hospital. By completing and signing this form you confirm the information you provided is correct and true to the best of your knowledge.

Owner's Signature *

Please type the letters and numbers shown in the image.