Name

First

Last

Email

Phone

Address

City

State/Province

Zip/Postal

Pet's Name

Species

Dog

Cat

Breed

Color

Age

Weight

Sex

Male

Female

Spayed/Neutered

Yes

No

How did you hear about our services?

Please list all veterinarians and pet care professionals who have seen your pet within the last 3 years:

After Care Arrangement Options

I will handle and take full responsibility for all after care arrangements myself. I am aware of any applicable laws and regulations regarding the burial of a pet’s body and understand caution should be taken when disposing of animals euthanized with drugs/chemicals.

I wish to have Happy Earth Pet Hospice transport my pet for after care (you must select one of the following)

Select One

Communal Cremation (no ashes returned)

Private Cremation (ashes returned to Owner/Agent)

Consent Statement

I certify that I am the legal owner/duly authorized agent for the owner of the animal described above, and do hereby give Dr. Wilson, Jeanette T Wilson DVM PLLC, Happy Earth Pet Hospice and any authorized agents, staff, or representatives full and complete authority to euthanize and handle after-care of said animal in a humane manner. I hereby forever release and hold harmless Dr. Wilson, Jeanette T Wilson DVM PLLC, Happy Earth Pet Hospice and any authorized agents, staff, or representatives from any and all liability for euthanasia and disposal of said animal. To the best of my knowledge, the dog or cat described above has not bitten, scratched, or otherwise potentially exposed any person or other animal to rabies in the past ten (10) days. I understand that if the animal described above has bitten or otherwise potentially exposed any person within the time specified, a rabies test must be performed. I understand that euthanasia is the act of ending the life of an animal in a painless way to prevent any unnecessary suffering. To the best of my knowledge, the information I have provided is accurate and complete. I understand that my wishes may be carried out immediately upon my signing this agreement. Fees for these services have been explained to me, and I assume full responsibility for all charges applicable to such services. I have carefully read and fully understand the foregoing provisions.

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Euthanasia Consent Form for Happy Earth Pet Hospice

Stay Connected with Us

Call or Text (252) 310-5858

124 Samson Way, Barco NC 27917

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