Veterinary Emergency + Referral Center
  • 24-HR ER: 808-735-7735
  • Our Services
    • Cardiology
    • Diagnostic Imaging
    • Emergency/Critical Care
    • Internal Medicine
    • Interventional Radiology
    • Neurology
    • Oncology
    • Surgery
  • For Your Pet
    • Client Registration Form
    • Emergencies + Appointments
    • When Your Pet is a Patient
    • Client Portal
    • Pet Insurance
    • Payment Options
    • Grief Resources
    • Animal Blood Bank of Hawaii
    • Clinical Studies
  • For Veterinary Teams
    • Our Referral Process
    • Submit Referrals
    • At a Glance
    • Ethos Materials for Clinics
    • Continuing Education
    • VetBloom CE
    • Clinical Studies
    • Animal Blood Bank of Hawaii
  • About Us
    • Our Hospital
    • Our Team
    • Why Ethos
    • Ethos Discovery
    • Contact Us
  • Blogs
    • Our Blogs
    • PAWEDcasts
  • We’re Hiring!
    • Apply Today
    • Job Fair Events
    • Benefits and Perks
    • Veterinary Training Programs
Veterinary Emergency + Referral Center
  • Our Services
    • Cardiology
    • Diagnostic Imaging
    • Emergency/Critical Care
    • Internal Medicine
    • Interventional Radiology
    • Neurology
    • Oncology
    • Surgery
  • For Your Pet
    • Client Registration Form
    • Emergencies + Appointments
    • When Your Pet is a Patient
    • Client Portal
    • Pet Insurance
    • Payment Options
    • Grief Resources
    • Animal Blood Bank of Hawaii
    • Clinical Studies
  • For Veterinary Teams
    • Our Referral Process
    • Submit Referrals
    • At a Glance
    • Ethos Materials for Clinics
    • Continuing Education
    • VetBloom CE
    • Clinical Studies
    • Animal Blood Bank of Hawaii
  • About Us
    • Our Hospital
    • Our Team
    • Why Ethos
    • Ethos Discovery
    • Contact Us
  • Blogs
    • Our Blogs
    • PAWEDcasts
  • We’re Hiring!
    • Apply Today
    • Job Fair Events
    • Benefits and Perks
    • Veterinary Training Programs
  • 24-HR ER: 808-735-7735

Medical Proxy

  • Authorization for Medical Care During Owner's Absence

    • I hereby give permission for the person listed below to bring my pets to Veterinary Emergency + Referral Center of Hawaii for treatment and/or surgery if it becomes necessary during my absence.
    • NameSpecies (Dog/Cat) 
  • Authorizations for Charges

    • We will not exceed the dollar amount provided above.
  • Contact Information

    A copy of this form will be emailed to you. Please print this form and ask your pet's caregiver to bring it with them, along with their ID in the event of an emergency.
    • We will use this to send you a copy of this form
    • I consent to an examination of my pet by the providers at this Veterinary Emergency + Referral Center of Hawaii. I understand that diagnostics and treatment along with the associated costs will be discussed prior to delivery and I have the right to decline. If my pet is hospitalized, I understand the provider will present an estimated treatment plan with the associated costs, however, treatment may vary throughout the duration of my pet’s stay. I will be informed of any costs that exceed the initial treatment plan so I am able to make informed decisions about my pet’s care.

      Payment is due at the time of service and any remaining balance must be paid when services are complete. All day services and hospitalizations require a deposit in full of the estimated cost.

      I understand that a photograph of my pet for identification purposes is captured and stored in the medical record. This is used identification and is not shared. This photo is compulsory as it ensures proper care for your pet while in our care.

      I am the legal owner or representative of the legal owner of the animal being presented and I am 18 years or older.
  • This field is for validation purposes and should be left unchanged.

Veterinary Emergency + Referral Center
808-735-7735 | 345 N. Nimitz Hwy, Unit C Honolulu, HI 96817
  • 24-HR ER: 808-735-7735
  • Our Services
    • Cardiology
    • Diagnostic Imaging
    • Emergency/Critical Care
    • Internal Medicine
    • Interventional Radiology
    • Neurology
    • Oncology
    • Surgery
  • For Your Pet
    • Client Registration Form
    • Emergencies + Appointments
    • When Your Pet is a Patient
    • Client Portal
    • Pet Insurance
    • Payment Options
    • Grief Resources
    • Animal Blood Bank of Hawaii
    • Clinical Studies
  • For Veterinary Teams
    • Our Referral Process
    • Submit Referrals
    • At a Glance
    • Ethos Materials for Clinics
    • Continuing Education
    • VetBloom CE
    • Clinical Studies
    • Animal Blood Bank of Hawaii
  • About Us
    • Our Hospital
    • Our Team
    • Why Ethos
    • Ethos Discovery
    • Contact Us
  • Blogs
    • Our Blogs
    • PAWEDcasts
  • We’re Hiring!
    • Apply Today
    • Job Fair Events
    • Benefits and Perks
    • Veterinary Training Programs
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