Euthanasia Authorization Form – No Cremation

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Euthanasia Authorization Form – No Cremation

Please fill out this form completely.

Name: *

First

Last

Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

I, the undersigned, do hereby certify that I am the legal owner or duly authorized agent for the owner of the following pet (pet name): *

Species: *

Dog
Cat

Sex *

Male
Female

Breed: *

I request, for humane reasons, that this pet be euthanized, and give my full consent for the attending veterinarian or certified technician to perform a humane euthanasia, forever releasing said doctor and agents of Woodhaven Animal Health from any and all liability for performing this final and irrevocable procedure. Furthermore, I certify that, to the best of my knowledge, this pet has not bitten any person or been exposed to rabies in the last 10 days. *

I understand and consent.

Personal Preference: *

I will be present for the procedure.
I do not wish to be present for the procedure.

Body Care Option: *

Take home

Signature: *

Clear Signature

Date: *

Euthanasia Authorization Form – No Cremation

Euthanasia Authorization Form – No Cremation

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