Euthanasia Authorization Form

Client Information

Name

Address

Primary Phone*

Email Address*

Secondary Contact

Secondary Phone Number

Patient Information

Pet's Name*

Pet Age

I the undersigned, do hereby certify that I am the owner or duly authorized agent for the owner of the animal described above, that I do hereby give the doctors of Emergency Pet Hospital of Redlands permission to euthanize and arrange for cremation for the pet mentioned above in whatever humane manner the doctors of Emergency Pet Hospital of Redlands, their agents, servants or representatives deem appropriate. I also release the doctors, Emergency Pet Hospital of Redlands, their agents, servants and representative from any and all liability for so euthanizing and cremating of pet.

I do also certify that to the best of my knowledge the said animal has not bitten any person or animal during the last fifteen (15) days and has not been exposed to rabies.

PLEASE INDICATE YOUR DECISION FOR CARE OF REMAINS BY CHECKING BELOW:

Learning the cause of death of your pet can be of great help in relieving the suffering of other pets, as well as contributing to our understanding of heath and disease. Unless you request otherwise, a postmortem evaluation may be performed on your pet prior to cremation. Should we choose to do this, you will not be charged unless you wish to receive a report.

OWNER/AGENT*