Euthanasia Consent Form - Bliss Family Veterinarian 33558

"*" indicates required fields

Date*

Owner Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Name of Pet*

Species*

Breed*

Color*

Age*

I, the undersigned, certify that I am the owner, or an authorized agent for the owner, of the above stated animal, and I consent to, and order euthanasia to be performed on the said animal. To the best of my knowledge, and belief, this animal has not bitten any person or animals during the past fifteen days and has not been exposed to rabies. I give Bliss Family Veterinarian, and representatives, full and complete authority to euthanize and handle the remains of the said animal in a humane manner and in accordance with the rules and regulations of the establishment. Furthermore, I forever release the doctor or representatives from any and all liability of the said euthanasia.*

I consent

Signature of Owner*

Please indicate your decision for care of remains by choosing below*

Take the body home immediately after euthanasia

Communal Cremation (Ashes not returned)

Private Cremation

Please hold remains pending our decision. I will be charged a communal cremation fee. If a decision is not made within one week of my pet’s euthanasia, a communal cremation will be performed.

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