Rescue Authorization Form

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Please fill out this form as completely as possible.

If you have any questions, please contact us!

(including but not limited to vomiting, diarrhea, coughing, sneezing, lethary, or loss of appetite.)
Click or drag files to this area to upload. You can upload up to 10 files.
**Hold down Shift or Command to select more than one procedure**
**Hold down Shift or Command to select more than one procedure**
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