I authorize the following person to act as my Authorized Agent for veterinary care at Fox Veterinary Hospital.

I understand and agree that my Authorized Agent is fully authorized to:

• Present my animal(s) for veterinary care
• Receive medical information and recommendations
• Approve diagnostics and treatment
• Sign estimates, consent forms, and discharge instructions
• Make medical decisions on my behalf, including emergency care
• Make humane euthanasia decisions if medically necessary

I acknowledge that Fox Veterinary Hospital may rely on this authorization unless and until I revoke it in writing.

FINANCIAL RESPONSIBILITY - I understand that I remain financially responsible for all charges incurred on my account, regardless of whether they are authorized by me or by my Authorized Agent.

TERM & REVOCATION - This authorization remains in effect until revoked by me in writing.
Revocation is not retroactive.

OWNER CONSENT - I certify that I am the legal owner or authorized responsible party for the patient(s) listed on this account.