• Euthanasia and Disposition Consent Form

  • --I certify that I am the owner or authorized agent of the owner, for the above named animal and hereby give a Forget-Me-Not Veterinary and it's Doctors full and complete authority to perform euthanasia (humanely terminate life) of my pet. Arrangements for aftercare will be based on the wishes of the owner/agent and documented above.

    --To the best of my knowledge, the information I have provided on this form is true. I do also certify that this animal has not bitten any human or other animal within the last 10 days. (This question is in regards to Rabies law for SC.)

     

  •  /  /
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  • TA:_________Bot:________

    Torb:________Bot:________

    X:________

    Euth:________Bot:________

    Time:________Date:_____________

    Clinician Signature:_____________________________

    Euth$______ After$______Misc$______ Total$______

    Cash  ____Check#______  Credit Card Last 4: ______________

    Drug Log:________           Card Sent:_______  Email Sent:_______

  • Should be Empty:
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