Euthanasia Consent Form

EUTHANASIA CONSENT FORM

(Euthanasia - the humane termination of life)

Owner's Name Owner's Address Owner's Home Phone Owner's Mobile Phone Owner's Email Patient Name Patient DOB/Age Patient's Breed Patient's Sex Patient's Color I, Consenting Owner Name am the owner or duly authorized agent of the owner for the above-named animal, I hereby consent to and request humane euthanasia for my pet by a veterinarian at this practice. I wish the body to be returned to me / the ownerI request cremation and that the ashes be returned to me / the ownerI request cremation but do not want the ashes returned to me / the owner Please sign here:
Doctor's signature: (to be signed later)
Witness name: (to be filled in later) Witnessed By Practice staff member name: (to be filled in later) Practice Staff Member Today's date: Date Signed By submitting this form, you agree to be contacted via the info given through email, phone call, or text message