Euthanasia Consent Form

Thank you for choosing Justin Animal Hospital for this deeply personal care. To enable us to provide their end-of-life care, please complete our required online Euthanasia Consent Form.

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Euthanasia Consent Form

Please complete this form as accurately as possible so we can proceed with your pet’s care. We are here to support you in any way we can during this difficult time.

Name *

First

Last

Address *

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Address Line 2

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State

Zip Code

Phone Number *

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By checking this box, you consent to receive informational and/or promotional text messages from Justin Animal Hospital at the number provided, including messages sent by the autodialer. Consent is not a condition of purchase. Message & data rates may apply. Message frequency varies. Unsubscribe at any time by replying STOP. Reply HELP for help. Privacy Policy.

Email *

Pet's Name *

Species *

Breed *

Color: *

Age: *

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

Owner Signature *

Clear Signature

Today's Date *

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Euthanasia Consent Form

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