Medication Permission Form

Mr/Mrs/Miss/Ms

First Name

Surname

Pet Name

Type of medication

Reason for medication

Instructions for administering medication

Dose

How many times per day?

Times to be administered (am/pm)

Please leave the complete container and instructions as printed on them by the VET to eliminate error.

WHere is the medicine stored?

I authorise Purrfect Scents Dog Walking & Pet Care to administer the stated medication to the above named pet for the duration of my absence and there after whenever Purrfect Scents Dog Walking & Pet Care cares for this pet.

Client Name

Date of Agreement