Patient's Name*

Weight*

Age or DOB*

Breed*

Sex

Owner's Full Name*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Who is the primary care veterinarian?

I authorize the euthanasia to be performed on: (Patient's name)*

For the aftercare of my pet, I would like:*

I also give consent for the attending veterinarian to schedule Good Shepherd for disposition of the remains.*

My pet has/has not had CBD or hemp oil in the last 6 months.*

Owner's Full Name (This acts as your signature)*

Date*

Comments

This field is for validation purposes and should be left unchanged.

Euthanasia Consent Form