Authorization to Make Treatment Decisions

Pet's Name(s):

Authorized individual(s)

Treatment authorization begins

Treatment authorization ends

If no end date is selected then authorization is in effect until we receive written notification from you to end the authorization

Additional Instructions

I, the undersigned owner of the pet(s) identified above, certify that I am eighteen years of age or over and authorize the listed individual(s) to make treatment decisions, up to and including euthanasia, for the pet(s) identified. I also agree to pay for all procedures/treatments performed and follow the financial policy of Mountain View Veterinary Health Center. Any payment arraignments must be made with the practice manager before services are performed. All fees are due at the time of service/discharge.

Please Type your name: *

Date: *

Email: *

You will receive pet health reminders, appointment reminders and other information from us through email. You can opt out of any type of email communication through our online portal or the email itself.

Phone

You may receive appointment reminders via text message. You can opt out of these reminders at any time.

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for your cats, dogs, and equine/horse chiropractic.

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Both practices will close at 5:00 PM on the first Wednesday of every month.
For information regarding clinic closures, please visit our social media pages.

Mountain View Veterinary Health Center is an accredited member of the American Animal Hospital Association (AAHA). Mountain View Veterinary Health Center first received this accreditation in 1977 and is proud to have been the first hospital, and one of only two in Cache Valley, to have this accreditation.

Since 1977 Mountain View Veterinary Health Center has undergone regular inspections by AAHA to ensure compliance with the association’s high quality standards of care. These standards cover nearly every aspect of the Mountain View Veterinary Health Center hospital, including: surgery, pharmacy, laboratory, exam facilities, pet health records, cleanliness, emergency services, dental and nursing care, diagnostic imaging, anesthesiology, and employee training and education.

Medical Decisions Authorization

Medical Decisions Authorization

Medical Decisions Authorization

Authorization to Make Treatment Decisions

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North Logan

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Medical Decisions Authorization

Medical Decisions Authorization

Medical Decisions Authorization

Authorization to Make Treatment Decisions

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North Logan

Providence

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