Please select your clinic: *

Owner's Name *

First

Last

Phone *

Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Pet's Name *

Species *

Dog
Cat

Breed *

Color *

Sex *

Male
Male (neutered)
Female
Female (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 understand

I 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 understand

I 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 understand

Signature *

Date *

Express Vets
Euthanasia Authorization Form

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.

Author

Express Vets Euthanasia Authorization Form

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.

Author

Express Vets
Euthanasia Authorization Form