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Euthanasia Consent Form Council Veterinary Hospital in Bethany, OK

Save time during your next appointment! Please fill out our Euthanasia Consent Form online from any device at any time before your visit.

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Euthanasia Consent Form

Please fill out this form as completely and accurately as possible for euthanasia.

Company *

Co-address

Address Line 1

Address Line 2

City

State

Zip Code

Date *

Case No: *

Owner: *

First

Last

Street: *

City: *

Phone *

Name: *

Breed: *

Sex:

Male
Female

Age: *

Color: *

Markings: *

I, the undersigned, do hereby certify that I am the owner (duly authorized agent for the owner) of the animal described above; that I do hereby give , his agents, servants, and representatives full and complete authority to euthanize the said animal in whatever manner the said Doctor, his agents, servants, or representatives shall deem fit.

I do hereby, and by these presents forever release the said Doctor, his agents, servants, or representatives from any and all liability for so euthanizing the said animal.

I do also certify that the said animal has not bitten any person or animal during the last fifteen (15) days, and to the best of my knowledge has notbeen exposed to rabies.

Signature

Name

Euthanasia Consent Form Council Veterinary Hospital in Bethany, OK

Euthanasia Consent Form

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