Euthanasia Consent

Please complete the euthanasia consent form before your appointment.

Please fill out the following form as thoroughly as possible. If you need immediate assistance, please call us. For more information on scheduling and our procedures, please see In-Home Euthanasia under our services tab.

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

Phone Number(Required)

Pet's Name(Required)

Species(Required)

Date of Birth/Approximate Age(Required)

Breed(Required)

Color(Required)

I, the undersigned, am at least 18 years old, and I am the owner / duly authorized agent for the owner of the animal described herein. I hereby consent to and order euthanasia(humane death) to be performed on this animal forever releasing said doctor, hospital, and all agents from any and all liability for performing said euthanasia. It is my desire to provide for my pet decent and humane after-death care, complying with all legal requirements of the area. I authorize the attending veterinarian to now dispose of the remains in accordance with hospital policy, releasing the hospital, doctor and agents from any and all liability for performing after-death care, with the following stipulations included:(Required)

I verify that the above stated pet has not bitten any person or animal during the last fourteen (14) days and to the best of my knowledge has not been exposed to rabies.(Required)

I agree

Signature(Required)

Date(Required)

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Name

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Euthanasia Consent

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