FORMS | Veterinary Northwest

Euthanasia Release Form

Client Name

Name of Patient

Age of Patient

Approximate weight

Color

I certify that I am the legal owner/approved agent for the owner of the animal described above. I hereby give authorization for Veterinary Northwest to perform euthanasia services and cremation services for said animal in a humane manner. I release and hold harmless Veterinary Northwest and its staff from any and all liability for euthanasia and disposal services of said animal.

To the best of my knowledge, this animal has not bitten, scratched, or otherwise potentially exposed any person or animal to rabies within the past ten (10) days. Furthermore, I understand that if the animal above has exposed any person/animal within the described time frame, a rabies test must be performed at the owner's expense.

I understand that euthanasia is the act of ending an animal's life to prevent any unnecessary and prolonged suffering.

I understand that Dr. Kuhn may perform a physical exam on my pet upon arrival and reserves the right to decline euthanasia services based on his medical assessment.

Select a date

Submission Successful