Euthanasia Consent Form

We want to make your vet experience as smooth as possible. Fill out your forms online here.

Appointment

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number *

Email *

Pet's Name *

Species *

Breed *

Color: *

Age: *

As part of our effort to support you through this difficult time, we offer the option of processing payment before your appointment. Once we have received your Consent Forms, would you like a CountryVets team member to call you to receive payment? *

Yes, I would like to take care of the payment prior to my appointment.
No, I will take care of the payment at the time of my appointment.

I, the undersigned, am at least 18 years old, and I am the owner / duly authorized agent for the owner of the animal described herein. I hereby consent to and order euthanasia (humane death) to be performed on this animal forever releasing said doctor, hospital, and all agents from any and all liability for performing said euthanasia. It is my desire to provide for my pet decent and humane after-death care, complying with all legal requirements of the area. I authorize the attending veterinarian to now dispose of the remains in accordance with hospital policy, releasing the hospital, doctor and agents from any and all liability for performing after-death care, with the following stipulations included: *

I verify that the above stated pet has not bitten any person or animal during the last fourteen (14) days and to the best of my knowledge has not been exposed to rabies. *

I agree

Signature *

Clear Signature

Date *

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