Euthanasia Consent Form

 519-696-3102 … Request an Appointment

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We will be closed on Saturday, Oct 12th and Monday, Oct 14th for the Thanksgiving Holiday Weekend. For emergency care please call the EVC of Waterloo Region at 519-650-1617 or our 24/7 Registered Veterinary Technician Hotline at 647-695-5411, for non-emergencies, try our SmartVet Telemedicine Service.

Client Care Center

Please complete this Euthanasia Consent Form just prior to entering Wilmot Veterinary Clinic

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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 *

Regular cremation - no ashes returned
Individual cremation - ashes returned
PawPrint
Home burial
Undecided
Special instructions - specify below

Please specify *

We offer you our deepest condolences during this difficult time.

 …