Euthanasia Consent Form

Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Pet Name*

Red Barn Veterinary Services
5680 140th Ave, SE
Sheldon, ND 58068
United States
(701) 882-3433

EUTHANASIA CONSENT FORM

I, the undersigned, hereby state that I am the [legal owner/legally authorized representative of the legal owner] of the above listed pet and authorized to make all medical decisions regarding this pet. I have declined any further care for the above pet and am hereby authorizing Red Barn Veterinary Services to euthanize the above listed pet.

I agree to have Red Barn Veterinary Services choose a euthanasia protocol at their sole and exclusive discretion and have had all my questions and concerns regarding this process answered prior to signing this consent. I attest that the above listed pet has not been exposed to rabies, has not bitten anyone, and has not displayed any signs of unusual attitude or aggression in the last 15 days.

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 Red Barn Veterinary Services to take charge of my pet's remains in accordance with hospital policy, releasing the staff from any and all liability for performing said after-death care.

Cremains Care*

Owner is keeping and will bury at home per county/city regulationsPrivate Cremation with Ashes returned; allow 2-3 weeks for deliveryCommunal Cremation - Ashes not returned to owner

Pawprints/ keepsakes

Yes, I would like pawprints/keepsakes created (no additional charge)No, I do not wish to have pawprints/keepsakes created

Signature*

Date*

Date