Consent for Euthanasia

Get Started

Consent for Euthanasia

So that we can prepare for your arrival, please complete and submit this form before your scheduled appointment time.

Printable Version

Name *

First

Last

Email *

Phone *

Cat's Name *

Approximate Age *

Breed (if known) *

Fur Color(s) *

Gender *

I certify that I am the legal owner/duly authorized agent for the owner of the cat described above, and do hereby give Whitney Odom, DVM, Atrium Cat Hospital, and any authorized agents, staff, or representatives full and complete authority to euthanize and handle aftercare of said cat in a humane manner. I hereby forever release and hold harmless Whitney Odom, DVM, Atrium Cat Hospital, and any authorized agents, staff, or representatives from any and all liability for euthanasia and aftercare of said cat. *

I have read and certify.

State law requires post-euthanasia rabies testing of any animal who has bitten a person or animal or been exposed to rabies virus in the last 10 days. I certify that to the best of my knowledge that said cat has not bitten any person or animal during the last 10 days and has not been exposed to rabies virus. *

I have read and certify.

I request that said cat's remains be cared for in the following manner (choose one): *

I will handle and take full responsibility for all aftercare arrangements myself. I am aware of any applicable laws and regulations regarding the burial of a pet’s body and understand caution should be taken when disposing of animals euthanized with drugs/chemicals.
I wish to have Atrium Cat Hospital arrange for my pet's aftercare.

I understand that euthanasia is the act of ending the life of an animal in a painless way to prevent any unnecessary suffering. To the best of my knowledge, the information I have provided is accurate and complete. I understand that my wishes may be carried out immediately upon my signing this agreement. Fees for these services have been explained to me, and I assume full responsibility for all charges applicable to such services. I have carefully read and fully understand the foregoing provisions. *

I have read and understand.

Signature *

Date *