Euthanasia Consent Form

Name(Required)

First Last

Phone(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Name of Animal:(Required)

Species(Required)

Breed(Required)

Color(Required)

Age(Required)

Preferred method of euthanasia:(Required)

Pentobarbital injection

Intrathecal lidocaine

I have read and understand this authorization. To the best of my knowledge, the information I have provided is true. I understand that my wishes may be carried out immediately upon my signing this agreement. Fees for these services have been explained to me.

Signature(Required)

48412

Euthanasia Consent Form

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