Euthanasia Consent Form

Our hearts are with you during this painful time. To continue with your pet’s end-of-life care, please complete our online consent form.

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Understanding the Process

We understand the weight of this decision, and our entire team is here to support you and your family. If you have any questions about the form or the procedure, please don’t hesitate to contact us.

Submit Your Consent Form

Use the form below to provide the necessary information and consent for your pet’s care. Completing this form helps us ensure your pet’s comfort and dignity throughout the process.

Owner Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

Phone Number(Required)

Pet's Name(Required)

Pet's Age (in years)(Required)

Species(Required)

Sex(Required)

Intact Male

Neutered Male

Intact Female

Spayed Female

Breed(Required)

Description(Required)

(Coat color and length, markings, etc.)

I, the undersigned, hereby certify that I am the owner, or an authorized agent of the owner, of the pet described above. I give Dr. Jerry Miller, DVM, and his agents, servants, or representatives full and complete authority to euthanize my pet in whatever manner they deem appropriate. I hereby release the doctor, his or her agents, and representatives from any and all liability for performing the euthanasia. I also certify that the pet described above has not bitten or scratched any person or animal in the past fifteen (15) days and, to the best of my knowledge, has not been exposed to rabies.

Signature of Owner or Authorized Agent(Required)

Today's Date(Required)

Euthanasia Consent Form

Understanding the Process

Submit Your Consent Form

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