Sample Consent Form For Euthanasia And Care For Remains printable pdf download

Sample Consent Form For Euthanasia And Care For Remains

Englewood Animal Health Center

1830 Placida Rd

Englewood Fl 34224

941-474-8881 Fax 941-473-0740

*An animal is currently vaccinated if he/she has been vaccinated with a three year rabies vaccine

in the past three years (or in the last year if a one year rabies vaccine was used) and such vaccine

was administered to the animal at least thirty days prior to having bitten any person or animal.

Revised 07/26/11

Consent Form for Euthanasia and Care for Remains

I certify that I am the owner (or a duly assigned agent for the owner) of the

animal described below. I give the doctors of Animal Hospital of Pensacola, their

staff, and/or representatives full and complete authority to euthanize and arrange

for care of the remains for this animal in the manner the doctors of Animal

Hospital of Pensacola, their staff, or their associates deem fit and release them

from any and all liability related to either action.

I also certify that to the best of my knowledge _____________ has not bitten

any person or animal during the last ten (10) days and has not been exposed to

rabies and have been currently* vaccinated for rabies.

___/___/___ _______________________________________

DATE SIGNATURE OF OWNER

_________________________ (___)____________________

_________________________

PHONE NUMBER

ADDRESS

Pet’s Name ________________ Color _________________

Species ________________ Sex _________________

Breed ________________ DOB _________________

We at Englewood Animal Health Center extend our deepest

sympathy in the loss of your pet.

Sample Consent Form For Euthanasia And Care For Remains