Authorization for Veterinary Treatment

V-SLIP #

Date(Required)

Activity Number(Required)

Animal ID(Required)

Department Code(Required)

Animal Name(Required)

if no name, enter "none"

Animal Color(s)(Required)

Animal Breed(s)(Required)

Veterinary Clinic(Required)

Veterinary Clinic Email(Required)

Enter Email Confirm Email

List Veterinary Clinics Full Name & Address(Required)

Animal Care(Required)

This animal has NOT been seen by a veterinarian

No medications have been administered

This animal has been seen by a veterinarian and medical records will be provided

Additional treatment and/or procedures have been requested and are authorized for reimbursement to include the following:

Additional notes/comments

Additional treatment/procedures(Required)

Additional notes/comments(Required)

Above named clinic is authorized to examine and perform medical procedures on above described animal to stabilize and relieve pain. Without consent of Humane Society, cost is not to exceed:(Required)

Approved by(Required)

First Last

Authorization for Veterinary Treatment

Colorado Springs

Pueblo

Animal Law Enforcement

Our sponsors