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Dr Duncan HoustonDr Duncan HoustonWritten by a practising veterinarian

Veterinary Euthanasia Consent Form

A free fillable euthanasia consent form for veterinary use. Type into the fields, sign on screen, then print it or save it as a PDF. Patient and owner details are never stored or sent anywhere.

Clinic

Clinic Details

Client

Client's Details

Patient

Patient's Details

Euthanasia

Euthanasia

Consent

Consent

I hereby request the humane euthanasia of the above animal. By signing this I confirm that I am the owner or an authorised agent of the owner and have read and understood this document. I also confirm that I am of or above the age of 18 years.

Owner / agent signature
Witness signature
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Veterinary Euthanasia Consent Form

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Veterinary Euthanasia Consent Form

Clinic Details

Date

Client's Details

First name
Last name
Address
Phone
Email

Patient's Details

Name
DOB (age)
Microchip
Weight (kg)
Gender
Desexed
Species
Breed
Colour
ID tag no.

Euthanasia

Date of euthanasia
Time of euthanasia
Sedation / induction
Veterinarian name
Aftercare requirement
Ashes to owner or clinic
Notes

Consent

I hereby request the humane euthanasia of the above animal. By signing this I confirm that I am the owner or an authorised agent of the owner and have read and understood this document. I also confirm that I am of or above the age of 18 years.

Owner / agent name
Date signed

Owner / agent signature

Witnessed by (name)
Witness role

Witness signature

Built by Dr Duncan Houston for Ask A Vet · askavet.com

Nothing typed into this form is sent to or stored by askavet.com. All data stays in your browser and leaves only in the PDF or printout you create. Check the consent and record-keeping requirements of your local veterinary regulator before use.

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Dr Duncan Houston
About the author

Dr Duncan Houston · BVSc, Veterinarian

Emergency careGeneral practiceMobile vet careFounder, ASK A VET™

Dr Duncan Houston is an Australian veterinarian with experience in emergency, general-practice and mobile veterinary care. He is the founder of ASK A VET™. This guide is educational and is not a substitute for hands-on veterinary care.

When Remember is on, this page saves your clinic's details in this browser only. Owner and patient details are never saved. It is never sent to Ask A Vet. Use Forget to remove them from this computer.