Euthanasia Form

Marked Fields are Required [*]

Date
MM slash DD slash YYYY
Owner*
First Last
Email*
Pet's Name*
Age:*
Species*
Breed:*
Dr:*
As the owner of this pet, I do hereby consent and grant the veterinarians of Lake Worth Animal Hospital and all of their employees, agents, or representatives (collectively, the "Hospital") full and complete authority for EUTHANASIA (Humane death) to be performed on this pet in whatever manner deemed fit by the attending veterinarian, and I do hereby forever release and discharge the Hospital from any and all liability. For performing said after death care with the following stipulations included.*
- I have read the above and I am in full agreement
PLEASE INDICATE YOUR DECISION FOR CARE OF REMAINS*
- Return remains for personal disposition
- Private cremation
- Communal cremation
- Please hold remains pending our decision
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