Emergency Veterinary Care Authorization

This Emergency Veterinary Care Authorization ("Authorization") is given by the undersigned horse owner ("Owner") to [FACILITY NAME], located at [FACILITY ADDRESS] ("Facility"). Its purpose is to let the Facility summon a veterinarian and approve emergency treatment for the Owner's horse when the horse's condition will not wait and the Owner cannot be reached. It states how much the Facility may spend on the Owner's behalf, names the veterinarians the Owner prefers, and records the Owner's standing instructions for hospitalization, surgery, and humane euthanasia.

Colic, laceration, choke, foaling complications, and similar emergencies can turn life-threatening within hours. Minutes spent trying to reach an owner can decide whether a horse survives. The Owner should keep the contact and veterinarian information on this form current and review it at least once a year.

1. Horse Identification

Horse Name (barn name and registered name): ______________________________

Breed: ______________________________

Age / Year of Birth: ______________________________

Sex: ______________________________

Color and Markings: ______________________________

Microchip / Tattoo / Brand Number: ______________________________

Stall / Paddock Location: ______________________________

2. Owner Contact Information

Owner Full Name: ______________________________

Mailing Address: ______________________________

Primary Phone (cell): ______________________________

Alternate Phone: ______________________________

Email: ______________________________

3. Emergency Contacts

If the Facility cannot reach the Owner, it will attempt to reach the following people, in order. Each contact should be someone who can make decisions for the horse and who has agreed to respond quickly.

Primary Emergency Contact — Name: ______________________________

Primary Emergency Contact — Relationship to Owner: ______________________________

Primary Emergency Contact — Phone: ______________________________

Backup Emergency Contact — Name: ______________________________

Backup Emergency Contact — Relationship to Owner: ______________________________

Backup Emergency Contact — Phone: ______________________________

4. Veterinarians

The Facility will first attempt to reach the Owner's preferred veterinarian. If that veterinarian is unavailable, cannot respond in time, or the emergency occurs outside the preferred veterinarian's service area, the Facility may use its backup veterinarian or the nearest available equine veterinarian or clinic.

Preferred Veterinarian / Clinic: ______________________________

Preferred Veterinarian — Phone: ______________________________

Facility Backup Veterinarian / Clinic: ______________________________

Facility Backup Veterinarian — Phone: ______________________________

Preferred Referral Hospital (for surgery or intensive care): ______________________________