Consent Form

Consent Form

End of Life Veterinary Care
Pet Information
Name

First NameLast Name
Breed
Age
Estimated weight (kg)
Regular Vet Clinic

If you have a regular vet clinic, they can be notified after Dr Caitlin visits, so that your records are updated.
Would you like your regular vet to be notified?

Yes pleaseNo thank you
Name of vet clinic
Client Information
Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Date

MonthDayYear
Date
Veterinarian details

Name: Dr Caitlin Wood BVSc MANZCVS PhD
Veterinary Registration Number: 4511
ABN: 20 650 442 065
I, the undersigned, confirm that I am the legal owner or authorised agent of the above-mentioned pet. I give my informed consent for the performance of humane euthanasia by the attending veterinarian named above. I understand the nature of the procedure, the irreversible outcome, and have had the opportunity to ask questions which have been answered to my satisfaction.

I confirm that I have considered all available options and have elected euthanasia as the most appropriate course of action in the best interest of my pet’s welfare.
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Pet Information