Consent for Euthanasia

APPOINTMENT

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Client Name *

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Pet Information

Pet's Name *

Date of Procedure *

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: *

Return remains for personal disposition
Communal cremation (no ashes returned)
Private cremation with ashes returned
Postmortem evaluation prior to the above disposition

I verify that said pet has not bitten any person or animal during the last ten (10) days and, to the best of my knowledge, has not been exposed to rabies. *

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Consent for Euthanasia

Complete this form before your visit.

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