Veterinary Euthanasia & End-of-Life Care Request
  • Veterinary Euthanasia & End-of-Life Care Request

    Submit your request and provide informed consent for veterinary end-of-life services. Please complete all required sections.
  • CLIENT (OWNER) INFORMATION

    Please provide your contact details as the primary owner.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • PET INFORMATION

    Tell us about your pet.
  • VETERINARY HISTORY

    Provide your pet's veterinary background.
  • Format: (000) 000-0000.
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  • CURRENT MEDICAL STATUS

    Describe your pet's current medical conditions and status.
  • Rows
  • MEDICATIONS

    List all current medications and allergies.
  • QUALITY OF LIFE (CVO-DEFENSIBLE)

    Please rate the following aspects of your pet's quality of life.
  • SERVICE REQUEST

    Select the service you are requesting and your preferred appointment details.
  • HOME & SAFETY DETAILS

    Tell us about your home environment to help us prepare for the visit.
  • AFTERCARE & REMAINS

    Select your preferences for aftercare and keepsakes.
  • ONTARIO-APPROPRIATE INFORMED CONSENT

    Please read the consent statement below and provide your agreement and signature.
  • INFORMED CONSENT FOR EUTHANASIA / END-OF-LIFE CARE (ONTARIO) I confirm that I am the legal owner or authorized agent for the above-named animal and have the authority to make medical decisions on their behalf. I understand that euthanasia is the humane administration of medications intended to painlessly and permanently end my pet’s life. I acknowledge that the attending veterinarian has explained: * The nature and purpose of euthanasia * The medications used * The expected process and outcome * Reasonable alternatives, including palliative or hospice care (where applicable) I understand that once euthanasia has been performed, death is irreversible. I acknowledge that while euthanasia is intended to be peaceful, rare and unforeseen reactions or complications may occur. I consent to humane euthanasia being performed by a veterinarian licensed to practise in Ontario. I understand that emotional responses by family members or other pets may occur and accept responsibility for maintaining a safe environment during the visit. I have selected and understand my aftercare and remains preferences. I understand the professional fees associated with this service and agree to payment as outlined. I release the attending veterinarian and clinic from liability except in cases of gross negligence or willful misconduct, in accordance with Ontario law. I give my informed consent freely and without coercion.
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  • ADMIN (OPTIONAL)

    For administrative use or additional preferences.
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