Authorization to Perform Euthanasia

Authorization to Perform Euthanasia

House Call Pet Service with Dr. Jennifer Barrington
Thank you for choosing House Call Pet Service for your veterinary care.

In-home euthanasia allows your pet to go with dignity and comfort in their normal environment. To learn more about In-Home Euthanasia at House Call Pet Service, please click here.

If you have any questions, please contact me.

Thank you,
Dr. Jennifer Barrington
House Call Pet Service, LLC

2397 NW Kings Blvd #120
Corvallis, OR 97330

housecallpetservice.com

Owner/Agent Information
Name*

First NameLast Name
Email*
example@example.com
Owner/Agent*

I am the pet's ownerI am a duly authorized agent of the owner
Pet Information
Pet Name*
Species/Breed*
Sex*

FemaleMale
Color*
Age*
Estimated weight*
if {petName} has not been seen by Dr. Barrington before, please click here and complete House Call Pet Service New Patient Registration Form too (opens in a new tab/window).

Service
Plan for aftercare of your pet’s remains

Left in your home for burial or owner to transport for cremationCremation with ashes back, Dr. Barrington to transportCremation with NO ashes back, Dr. Barrington to transport
Authorization to Perform Euthanasia
I, {fullName}, the owner or duly authorized agent of the owner of {petName}, hereby consent to, and order, euthanasia to be performed on {petName} for humane reasons, by Dr. Jennifer Barrington.

To the best of my knowledge and belief, {petName} has not bitten any person during the fifteen days preceding this day.
Signature*

Clear
Thank You
Again, thank you for choosing House Call Pet Service for your veterinary care.

Again, if {petName} has not been seen by Dr. Barrington before, please click here and complete House Call Pet Service New Patient Registration Form too (opens in a new tab/window).

See you soon,
Dr. Jennifer Barrington
Should be Empty:

Thank You