Meridian Mobile Veterinary Care PLLC

Making the decision to euthanize your pet is never easy. In many cases, however, it is the kindest decision that you as an owner can make. Before you sign this form, it is important that you are as comfortable as you can possibly be with your decision and that all of your questions about your pet’s health, options other than euthanasia (if applicable), and the euthanasia procedure have been answered.

Owner’s Name _________________________________________________ Date ___________

Street Address _________________________________________________________________

Telephone ___________________________________ home/cell/work (please circle)

Pet’s Name ______________________________________________

Species ______________Breed ________________________ Color ________________

Age _________________Approximate Weight _______________ Sex _______________

I, the undersigned, certify that I am the owner/guardian of the animal described above and that I am over the age of eighteen. I do herby give Meridian Mobile Veterinary Care PLLC, its doctors, agents, and representatives, full and complete authority to conduct humane euthanasia and assist in the aftercare as prescribed by me. I release the doctor, agent, and/or representative from any and all liability for the euthanasia of the animal described above.

I certify that, to the best of my knowledge, the animal described above has not bitten any person or animal during the last fifteen days and has not been exposed to rabies.

I acknowledge that Meridian Mobile Veterinary Care PLLC does not allow photography or video recording of the euthanasia procedure.

Signature of Owner: ___________________________________________________ Date ___________

Owner’s Printed Name: _________________________________________________________________

Please Initial your choices below:

I elect to organize disposition of remains (in accordance with local regulations)  _______

I elect to have communal cremation (remains will not be returned to me) _______

I elect to have private cremation and ashes returned to me _______

I authorize Meridian Mobile Veterinary Care PLLC or their Cremation Partners to transport my pet for cremation _______