I certify I am 18 years old or older and the owner or authorized agent of the owner, for the above named animal.
I hearby request and fully authorize Hamilton - Niagara Veterinary Mobile Euthanasia Services to perform euthanasia for the above referenced patient.
I confirm that this animal has not bitten, seriously scratched or exposed any person or animal to Rabies within the previous fifteen (15) days.
I understand that euthanasia will be performed in a humane and compassionate manner.
Fees for these services has been explained to me and will be collected at the time of service or before if I prefer to take care of finances prior to the appointment.
To the best of my knowledge, the information I have provided on this form is accurate and true.