I, the undersigned owner of my pet below named hereby appoint:
as my agent to make any and all health care decisions for my pet, except to the extent l state otherwise in this document. My agent shall follow my wishes, as set forth through this document or other means. If my agent cannot determine the choice 1 would want for my pet, then my agent's decision shall be based on what he or she believes is in my pet's best interest. This medical power of attorney takes effect if 1 become unable to make health care decisions for my pet and this fact is certified in writing by me or my physician.

I understand that this power of attorney revokes any prior medical power of appointment and shall exist indefinitely from the date l execute this document unless I establish a shorter time or revoke this power of attorney. If 1 am unable to make health care decisions for my pet and this power of attorney expires, the authority 1have granted to my agent shall continue to exist until the time 1 am able again to make health care decisions for my pet.

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