Longenbaugh Veterinary Hospital P.C.

15703 Longenbaugh, Ste. F
Houston, TX 77095

(281)856-7023

longenbaughvet.com

If you wish for more than one person to have the right to sign authorization forms or make payment for services for your pet, this person must be listed in our records as a co-owner or agent of owner. You may use this form to add the name to your records.  By signing an authorization form, an owner or co-owner is agreeing that they fully understand the services being offered, they want the services being offered, and they will pay for all charges for services rendered including any additional costs not listed on an estimate, but on the final bill.  All questions or concerns regarding services or costs should be stated and resolved before any services are rendered. 



You can print the form and bring it with you or you may submit the form directly from our website. By submitting a form directly from our website, you are agreeing that the form will serve as a signed form.  Thank you.  If you have any questions, please call us at 281-856-7023.                                                                            

 


Only an owner , co-owner, or agent of owner may authorize services or make payment for services for a pet. Please fill in the spaces below for our records.
*Pet's Name
*Owner's name
*Agent of Owner Name

As owner of this pet, I give my permission to the agent listed above to authorize services and make payment for services for my pet. I understand that I am responsible for all charges for services including those authorized by my agent.

I understand that this submitted form will serve as my signature as the owner of this pet.
*Date
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