Veterinary Death Certificate
Certificate Details
- Date issued
Owner's Details
- First name
- Last name
- Address
- Phone
Animal's Details
- Name
- DOB (age)
- Microchip
- Gender
- Species
- Breed
- Colour
- Markings
Details of Death
- Date of death
- Time of death
- Place of death
- Manner of death
- Cause of death
- Cause established by
- Aftercare
- Notes
Veterinary Certification
I, the undersigned veterinary practitioner, certify that the animal described above is deceased and that the details recorded on this certificate are true and accurate to the best of my knowledge. Where the manner of death is recorded as humane euthanasia, I certify that it was performed humanely by me or under my direct supervision. Where possible, the identity of the animal was confirmed by microchip scan.
- Veterinarian name
- Registration number
- Practice name and address
- Phone
- Date signed
Veterinarian signature
Clinic stamp
