"Pet Euthanasia Consent Form"

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Pet Euthanasia Consent Form
Pet Name:
Pet Owner:
Date:
Pet ID No.
Phone:
Email:
Species:
Breed:
DOB:
Age:
Sex:
Neutered/Spayed?
Weight:
Color:
Size:
Markings:
Breeding Origin:
Date Acquired:
Acquired from:
Reproductive History:
Referred from:
Primary Veterinarian:
I, the pet owner, hereby accept full and total responsibility for the remains after the procedure. I
have read up on all applicable laws concerning disposal of remains. I understand laws and the
inherent dangers of disposing of animals that have been euthanized with chemicals.
I agree to release the remains to this veterinary hospice and  would  would not like the
cremated remains returned to me.
I hereby certify that I am the legal and rightful owner of the pet mentioned above. I authorize this veterinary
hospice and all veterinarians, agents, staff, and representatives therein to euthanize and dispose of said animal.
I release and hold harmless all agents, staff, and representatives from any liabilities that may arise from the
euthanasia and disposal.
I further swear and verify that the aforementioned animal has not scratched or bitten anyone in the last ten (10)
days. If the animal has scratched or bitten anyone in the last ten days, the animal is required to have a rabies
test before euthanasia takes place.
I understand that the euthanasia process is used to painlessly put down animals. I have read the information
provided on the subject. I understand that the process may begin immediately following my signing of this
document.
Signature
Date
www.FreePrintableMedicalsForms.com
Pet Euthanasia Consent Form
Pet Name:
Pet Owner:
Date:
Pet ID No.
Phone:
Email:
Species:
Breed:
DOB:
Age:
Sex:
Neutered/Spayed?
Weight:
Color:
Size:
Markings:
Breeding Origin:
Date Acquired:
Acquired from:
Reproductive History:
Referred from:
Primary Veterinarian:
I, the pet owner, hereby accept full and total responsibility for the remains after the procedure. I
have read up on all applicable laws concerning disposal of remains. I understand laws and the
inherent dangers of disposing of animals that have been euthanized with chemicals.
I agree to release the remains to this veterinary hospice and  would  would not like the
cremated remains returned to me.
I hereby certify that I am the legal and rightful owner of the pet mentioned above. I authorize this veterinary
hospice and all veterinarians, agents, staff, and representatives therein to euthanize and dispose of said animal.
I release and hold harmless all agents, staff, and representatives from any liabilities that may arise from the
euthanasia and disposal.
I further swear and verify that the aforementioned animal has not scratched or bitten anyone in the last ten (10)
days. If the animal has scratched or bitten anyone in the last ten days, the animal is required to have a rabies
test before euthanasia takes place.
I understand that the euthanasia process is used to painlessly put down animals. I have read the information
provided on the subject. I understand that the process may begin immediately following my signing of this
document.
Signature
Date
www.FreePrintableMedicalsForms.com