Euthanasia Consent Form
Name
*
First Name
Last Name
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Authorization and Release
Please check this box
I certify that I am the legal owner/duly authorized agent for the owner of the animal described above, and do hereby give Massie Veterinary Services and any authorized agents, staff, or representatives full and complete authority to euthanize and dispose of said animal in a humane manner. I hereby forever release and hold harmless Massie Veterinary Services and any authorized agents, staff, or representatives from any and all liability for euthanasia and disposal of said animal. To the best of my knowledge, my pet has not bitten, scratched, or otherwise potentially exposed any person or other animal to rabies in the past ten (10) days.
Please check this box
I understand that if the animal described above has bitten or otherwise potentially exposed any person within the time specified, a rabies test must be performed. I understand that euthanasia is the act of ending the life of an animal in a painless way to prevent any unnecessary suffering. To the best of my knowledge, the information I have provided is accurate and complete. I understand that my wishes maybe carried out immediately upon my signing this agreement. Fees for these services have been explained to me, and I assume full responsibility for all charges applicable to such services. I have carefully read and fully understand the foregoing provisions.
Please check this box
I will handle and take full responsibility for all after care arrangements myself. Iam aware of any applicable laws and regulations regarding the burial of a pet’s bodyand understand caution should be taken when disposing of animals euthanized withdrugs/chemicals.
I wish to have Massie Veterinary Services arrange for my animal's aftercare (you must select one of the following):
Pets: Communal Cremation (no ashes returned)
Pets: Private Cremation with ashes returned to me
Horses/Livestock: Private Large Animal Hauling
Signature
Date Signed
-
Month
-
Day
Year
Date
Submit
Submit
Should be Empty: