Euthanasia Consent Form
I, the undersigned, am the Owner or duly authorized agent of the owner of the animal described hereon. I verify that said pet has not bitten any person during the last ten (10) days and to the best of my knowledge has not been exposed to rabies. I hereby consent to and request humane euthanasia for my pet and release the doctor and staff from all claims of negligence arising from or connected to this life-ending procedure and the subsequent disposal of my pet.
It is my desire to provide decent and humane after care for my deceased pet that complies with all state, provincial, and local laws. I have been informed of all my options for disposal of the body and hereby authorize the attending veterinarian to dispose of the remains in accordance to hospital policy and via the option I have selected below:
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Return Remans to me for personal disposal
Cremation with no returned ashes(communal cremation)
Cremation with ashes returned back to me
Date
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Month
-
Day
Year
Date
Pet's Name
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Pet's Weight
*
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
example@example.com
Signature
*
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Should be Empty: