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Authorization to Perform Euthanasia

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Client First Name*

Client Last Name*

Pet's Name*

I, the undersigned, am the owner or dually authorized agent of the owner of the animal described hereon. I verify that said pet has not bitten any person or animal during the last ten (10) days and to the best of my knowledge has not been exposed to rabies.

I hereby consent to and request humane euthanasia for my pet and release the doctors and staff at Oakview Veterinary Medical Center from any and all claims, except claims for negligence, arising from or connected with this life-ending procedure and the subsequent disposition of my pet’s remains.

It is my desire to provide decent and humane after-care for my deceased pet that complies with all state, provincial, and local laws. I have been informed of all my options for after-care of the body and hereby authorize the attending veterinarian to release the remains in accordance with hospital policy and via the option/s selected below.

Cremation Options*

Return Remains to me

Cremation – group/communal (no ashes returned)

Cremation – private (ashes returned)

I understand that if I elect a private cremation, I will be contacted directly by Little Paws Cremation Service to schedule a time for my pet’s remains to be delivered directly to me. I understand that once my pet’s remains are released to the cremation service, Oakview Veterinary Medical Center is not liable for their return.

Phone*

Paw Print Keepsake*

Yes

No

Other Requests

Signature*

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