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

Date

After Care Options

Please select an aftercare option

Please specify

We offer you our deepest condolences during this difficult time.