Authorization of Euthanasia Form

The Authorization of Euthanasia Form allows pet owners to make important decisions with care and compassion for their animal’s final moments. Completing this form ensures our team can honor your wishes and provide support during this difficult time.

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Pet’s name *

Owner’s Name *

First

Last

Owner’s Email *

Date

Species (dog, cat, etc.) *

Breed *

Age *

Sex *

Color *

I, the undersigned certify that I am the owner, or authorized agent for the owner, of the animal described above. I do also certify that the said animal has not bitten a person or animal during the last (10 days), and to the best of my knowledge has not been exposed to rabies. On this date, I do hereby give doctors of Groesbeck Animal Hospital full and complete authority to perform euthanasia of above described animal, provide for final disposition of the remains and I release them from any and all liability. *

I, the undersigned certify that I am the owner, or authorized agent for the owner, of the animal described above. I do also certify that the said animal has not bitten a person or animal during the last (10 days), and to the best of my knowledge has not been exposed to rabies. On this date, I do hereby give doctors of Groesbeck Animal Hospital full and complete authority to perform euthanasia of above described animal, provide for final disposition of the remains and I release them from any and all liability.

I request the final disposition of my animal’s remains to be following

I will take the remains for burial
I request my animal’s remains to be cremated in accordance with hospital policy
I request my animal’s remains to be cremated and the ashes returned to me
I give permission for postmortem examination of the animal

I request the final disposition of my animal’s remains to be following

I will take the remains for burial
I request my animal’s remains to be cremated in accordance with hospital policy
I request my animal’s remains to be cremated and the ashes returned to me
I give permission for postmortem examination of the animal

Signature *

Clear Signature

Owner's Name *

Date

Authorization of Euthanasia Form

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