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Euthanasia Consent Form

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Euthanasia Consent Form

Date *

Owner’s Name *

First

Last

Address

Address Line 1

Address Line 2

City

State

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Phone *

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Patient’s Name *

Species *

Breed *

Age

Color

I certify that I am the owner (Duly authorized agent for the owner) of the animal described above, that I do hereby give

Yes, I accept

Doctor and his agents, servants, and representatives full and complete authority to Euthanize and/or dispose of said animal in a humane manner. I release the Doctor or Representatives From any and all liability for Euthanasia of the said animal, I do also certify that to the best Of my knowledge the said animal has not bitten any person or animal During the last fifteen (15) days, and has not been exposed to Rabies.

Yes, I accept

Euthanasia Consent Form

Euthanasia Consent Form

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