Euthanasia Consent Form

Save time at Foothill Farms Veterinary Hospital by completing your euthanasia consent form online before your visit.

Euthanasia Consent Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

Pet Owner’s Name: *

First

Last

Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number: *

I consent to receive SMS text messages from Foothill Farms Veterinary Hospital. Msg & data rates may apply. Reply STOP to opt-out. *

Yes
No

Patient Name: *

Species *

Breed *

Age *

Color *

I certify that I am the owner (Duly authorized agent for the owner) of the animal described above, that I do hereby give *

Yes, I accept

Doctor and his agents, servants, and representatives full and complete authority to Euthanize and/or dispose of said animal in a humane manner. I release the Doctor or Representatives From any and all liability for Euthanasia of the said animal, 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. *

Yes, I accept

Date *

Euthanasia Consent Form

Euthanasia Consent Form

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