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  • Euthanasia Authorization Form

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  • Authorization for Humane Euthanasia

  • I am the legal owner or duly authorized agent for the owner of the animal described above and do hereby give House Call Vet RVA and the veterinarian licensed to perform euthanasia, Dr. Kaitlyn Hemsley, full and complete authority to euthanize and dispose or arrange for cremation of said animal in a humane manner. I hereby forever release Dr. Kaitlyn Hemsley, DVM, of the facility, House Call Vet RVA, from any and all liability for euthanasia and disposing of said animal. House Cal Vet RVA, and the licensed veterinarian performing euthanasia services, Dr. Kaitlyn Hemsley, to choose a euthanasia protocol at their sole and exclusive discretion. I understand that any questions or concerns regarding euthanasia services requested for the animal listed above should be asked prior to signing this consent.

    *   I have read and understand the above authorization for humane euthanasia and release all liability as stated above

  • I * do certify to the best of my knowledge the animal listed above has not bitten, seriously scratched, or exposed anyone to rabies within the past l0 days. I am aware that Virginia law requires proof of prior rabies vaccination and may require post euthanasia rabies testing of any animal who has bitten a person(s) or another animal or been exposed to a rabid animal or person(s) within the past 10 days. Remains cannot be returned after rabies testing. Ashes may be returned if requested below.      

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  • * I have read, understand and agree to House Call Vet RVA, Appointment & Payment Policy.

  • Electronic Signature Agreement

    By signing and typing my name below I agree to signing this authorization form electronically
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