Euthanasia Authorization -

Client Information

Name

First Last

Address

Street Address Address Line 2 City State ZIP Code

Phone

Pet Information

Pet's Name

Pet's Species

Would you like us to notify your regular veterinarian?*

Yes
No

Name of veterinary hospital/clinic you would like us to notify*

Location for appointment

This should be in a garage, carport, screened-in porch, or in an area of your home where doors or windows can be opened.

Consent

Date*

Consent*

√ I certify that I am the legal owner/duly authorized agent for the owner of the animal described above, and do hereby give Dr. Turenne of Four Paws Veterinary Wellness and any authorized agents, staff, or representatives full and complete authority to euthanize and dispose of said animal in a humane manner. Unless otherwise agreed upon, disposition of the body of said animal is left to the judgment of the veterinarian.

√ I hereby forever release Dr. Turenne, Four Paws Veterinary Wellness and any authorized agents, staff, or representatives from any and all liability for euthanasia and disposition of said animal.

√ To the best of my knowledge, the above described pet has not bitten, scratched, or otherwise potentially exposed any person or other animal to rabies in the past ten (10) days.

√ I understand that if the animal described above has bitten or otherwise potentially exposed any person within the time specified, a rabies test must be performed. I have read and understand this authorization. To the best of my knowledge, the information is true. I understand that my wishes may be carried out immediately upon my signing this agreement. Fees for these services have been explained to me.

Signature*

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Typed Signature*

Please type your signature out

Euthanasia Authorization

Client Information

Pet Information

Consent

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