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Euthanasia Form

Save time during your appointment by completing your required euthanasia form online from any device at any time before your visit.

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Euthanasia Form

Please fill out this form as completely and accurately as possible before your visit.

Owner Information

Owner's Name *

First

Last

Email *

Phone: *

Address *

Address Line 1

City

State

Zip Code

Pet Information

Pet’s Name: *

Breed: *

Sex: *

Age: *

Color and Markings: *

I, the undersigned, do with this certify that I am the owner (or duly authorized agent for the owner) of the animal described above.

I give Dr. Sebastiao the complete authority to euthanize the above-described animal and forever release the said Doctor from all liability for euthanizing the said animal.

To the best of my knowledge and belief, this animal has not bitten any persons during the previous 15 days and has not been exposed to rabies.

This animal should be:

Please initial on following *

Returned to owner for burial
Communal cremation
Cremated with ashes returned to owner
Other

Owner Signature *

Clear Signature

Today's Date *

Phone

online form

Euthanasia Form

Euthanasia Form

Owner Information

Pet Information

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