Tequesta Veterinary Clinic - Euthanasia Form

Euthanasia Consent Form
Owner Name*

First NameLast Name
Owner Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Owner Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Owner Email Address*
example@example.com
Pet Name*
MaleFemale
We understand that this is an emotionally difficult time for you and your family, and with that in mind, we offer some options to help make this decision as easy as possible. Please review and initial the following:
YesNo
Yes, I would like to be present.No, I would prefer not to be present.
Yes, please administer.No, do not administer.
Private cremation with return of ashes.Cremation with no return of ashes. My pet's remains will not be returned to me.Home burial. I wish to take my pet's body home.
My pet has NOT bitten a person or animal in the last 10 day.My pet HAS bitten a person or animal in the last 10 days.
I have read and understand this authorization and fees have been explained to me. Please initial below:*
Today's Date*

MonthDayYear
Date
Owner Signature*
Should be Empty:

Euthanasia Consent Form