Pet Medical Instructions Form

Please complete the following form for each pet and each medication.

I do swear and affirm that the information below is 100% correct regarding administering ANY medicine or herbal formulas to my pet(s). Santorelli Services will not be responsible for a negative result that may arise from administering the medications or herbal formulas listed below with your signature and date per your instruction. You also agree that if anything has changed from one time to the next time we would care for your pets, that you will fill out another one of these forms to properly reflect any changes even if the change is small.

Santorelli Services are not vets and by law cannot change any dosages that the pet owner has listed and cannot "guess" what you mean or what your vet means. It can be very dangerous if the correct dosages of certain things are not properly communicated to us and could result in an emergency situation if not administered correctly. If their is a syringe to be used to administer meds, each and every syringe that would be used must be marked with the correct dosage with a sharpie.

You also swear and affirm that you have given the correct and valid email address that you check, phone number and emergency contact numbers on the agreement for services form.

Pet Name:
Medication:
Dosage:
Frequency:
Medication delivery Instructions:

(if a syringe is to be used, each one MUST be marked at the correct dosage)

Signature:

Date: Friday, 24-Nov-2017 10:42:34 PST