HAPPY PAWS HOUSE CALLS: EUTHANASIA AUTHORIZATION

HAPPY PAWS HOUSE CALLS: EUTHANASIA AUTHORIZATION

Euthanasia is ending the life of an individual animal in a way that minimizes or eliminates pain and distress.
Client Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*

Area CodePhone Number
Pet Name*
Species*

DogCat
Breed*
Age*
Weight (Approximate)*
Gender*

MaleFemale
Color / Distinguishing Features*
Reason for Euthanasia?*
After Care Options
Please select one of the following:*

Private CremationCommunal CremationHome Burial
Would you like a clay paw print for an additional charge? (Excludes home burial)

YesNo
If you answered yes for paw prints:
Quantity of clay paw prints
If you would like additional options for memorial products, please visit www.finalgift.com/memorial-products/ and let Dr. Mini know when she visits you.
Euthanasia Authorization

Please read, confirm, initial and date below.
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 Happy Paws House Calls 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 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.
Date*

MonthDayYear
Date
Client Initials*
Should be Empty:

HAPPY PAWS HOUSE CALLS: EUTHANASIA AUTHORIZATION

After Care Options

Euthanasia Authorization