Euthanasia Consent Form

Your Name

First Last

Email

Address*

Street Address City State ZIP Code

Phone*

Pet's Name

Weight of Pet

Breed

Sex

Age

I certify that I am the owner of:*

I also certify that this pet has not bitten a person or animal in the past ten (10) days and, to the best of my knowledge, has not been exposed to Rabies.*

Regular veterinarian name and hospital*

I give Dr. Becca Klobuchar with Zen Pet complete authority, in the peaceful and humane passing of this pet and release Dr. Klobuchar from any and all liability.*

Cremation

Paw Print

Hidden

Clay Paw Print

Yes
No

Please type name below and submit form to complete authorization*