Information sharing consent form-PAWSAU

Information sharing consent form

To ensure that your pet receives the best possible treatment and care, it may be necessary for us to share information with your pets regular Veterinarian. Please complete this form to give consent for us to liaise with your Veterinarian and share information between us regarding your pets history, treatment and care plan. A copy of this form will be sent to your Veterinarian as they will need to ensure that consent has been obtained. In addition, they may call you directly to confirm. Your records will remain private and confidential between your Veterinarian and Pets and Wildlife Service AU Pty Ltd. Consent can be withdrawn at any time by sending us an email at admin@pawsau.com

First Name

Last Name

Address

Phone Number

Pet name

Pet Breed

Colour

Male or Female

Male

Female

Date of Birth

Microchip Number

I consent for Pets and Wildlife Services AU to obtain the medical history from my Veterinarian for my pet as listed above

I consent for my Veterinarian to obtain the history from Pets and Wildlife Services AU for my pet as listed above

I am over 18

Your Signature