Euthanasia Consent Form - Wilmot Veterinary Clinic

I, the undersigned, hereby certify that I am of age of majority and:

I am the lawful owner of the pet described hereunder. *

I have read and understand

I hereby give my consent for euthanasia of my pet. *

I have read and understand

I hereby declare that my pet has not bitten anyone in the past 10 days. *

I have read and understand

I hereby give my consent for cremation of my pet after euthanasia. *

I have read and understand

I have been informed that an autopsy (post-mortem) of my pet can be performed at an additional cost. *

I have read and understand

I have chosen to accept or decline the autopsy of my pet. *

I accept
I decline

I hereby indemnify the veterinarians and staff of this clinic against any claims of whatsoever nature flowing from or related to the euthanasia of the pet described hereunder. I have read and fully understand this form and declare I voluntarily provide my informed consent. *

I have read and understand

Details of my pet

Pet's Name *

Species *

Breed *

Age *

Gender *

Male
Female

Details of Owner

Name *

First

Last

Address *

Address Line 1

City

State / Province / Region

Postal Code

Country

Phone *

Email *

Signature *

Date *

After Care Options

Please select an aftercare option *

Please specify *

We offer you our deepest condolences during this difficult time.