EUTHNASIA FORM CLIENT INFORMATION First Name* Last Name* Telephone number* PATIENT INFORMATION Pet's Name* Please Select*DogCatOther Please Specify* Reason for euthanasia —Please choose an option—SickOld AgeBehavioralother Cremation Requested*:—Please choose an option—Private CremationGroup CremationNo Cremation Requested I hereby certify that I am the owner of the animal described above I hereby give Wellness Veterinary Clinic full authority to euthanize my animal I hereby release Wellness Veterinary Clinic for any and all liability for euthanizing the said animal. I hereby certify that the said animal has not bitten any person or other animal during the last five days and to the best of my knowledge has not been exposed to rabies. Signature By clicking 'Submit', you agree to Wellness Veterinary Clinic Terms of Use and Privacy Policy. You consent to receive phone calls and SMS messages from Wellness Veterinary Clinic to provide updates on your order and/or for marketing purposes. Message frequency depends on your activity. You may opt-out by texting 'STOP'. Message and data rates may apply. Reply HELP for more assistance
