(Euthanasia - the humane termination of life)

    I, am the owner or duly authorized agent of the owner for the above-named animal, I here by consent to and request humane euthanasia for my pet by a veterinarian at this practice.

    Please sign here:

    Doctor's signature: (to be signed later)

    Witness name: (to be filled in later)

    Practice staff member name: (to be filled in later)

    Today's date: