Euthanasia Consent Form

Owner Information

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City ZIP Code

Preferred Number(Required)

Number we can use to reach you

Email(Required)

Pet Information

Pet’s Name(Required)

Age(Required)

Sex(Required)

Male, Intact

Male, Neutered

Female, Intact

Female, Spayed

Species(Required)

Breed(Required)

Color(Required)

Final Arrangements

Please select from the options below(Required)

General Cremation

Private Cremation

Memorial Services(Required)

Ink Paw Print

Clay Paw Print

None

I certify that I am the owner (or representative for) of the animal described above. I give the doctor complete authority to euthanize this animal, understanding that the animal will be treated humanely. I also certify to the best of my knowledge that this animal has not bitten any person or animal in the past 15 days or been exposed to rabies.(Required)