Express Vets Euthanasia Authorization Form Primary Care For Pets™ Use the form below to submit your euthanasia authorization form. We understand this is a very difficult time for you, please let us know how we can help. Please enable JavaScript in your browser to complete this form.Please select your clinic: *CummingNorth CantonHolly SpringsKennesawBufordOwner's Name *FirstLastPhone *Email *Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePet's Name *Species *DogCatBreed *Color *Sex *MaleMale (neutered)FemaleFemale (spayed)Age/Date of Birth *I, the undersigned, do hereby certify that I am the owner (duly authorized agent for the owner) of the animal described above; that I do hereby give Express Vets LLC, DVM, his/her agents, servants, and representatives full and complete authority to euthanize the said animal in whatever manner the said Doctor, his/her agents, servants, or representatives shall deem fit. *I have read and understandI do hereby, and by these presents, forever release the said Doctor, his/her agents, servants, or representatives from any and all liability for so euthanizing the said animal. *I have read and understandI do also certify that the said animal has not bitten any person or animal during the last fifteen (15) days, and to the best of my knowledge, has not been exposed to Rabies. *I have read and understandSignature *Clear SignatureDate *Submit Author Erika Nielsen View all posts