Euthanasia Consent Form Please fill out the form below. Euthanasia Consent Form Name * Name First Name First Name Last Name Last Name Email * Phone * Address * Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Patient Name * Species * Canine Feline Sex * Male Male/Neutered Female Female/Spayed Breed * Color * I do hereby certify that I am the owner or the duly authorized agent for the owner of the animal described above, that I do hereby give the doctors of Olmito Veterinary Hospital permission to euthanize and dispose of said animal in whatever humane manner the doctors of Olmito Veterinary Hospital, their agents, servants or representatives deem appropriate. I also release the doctors, Olmito Veterinary Hospital, their agents, servants and representative from any and all liability for so euthanizing and disposing of said animal. * Yes, I give my permission No, I don't give my permission Please select one of the following for disposition of remains * Home Burial (no charge, we package your pet nicely for home burial) Cremation (no ashes returned to you, they are dispersed by the crematorium) Signature * signature keyboard Clear Date * Submit If you are human, leave this field blank.
