John the Vet
166 Jasper Road Bentleigh, VIC 3204 Ph: (03) 9563 9711

Euthanasia Authorisation

Date:
Client Name:
Address:
Telephone:
Animal name:
Species and Breed:
Sex:
Age or date of birth:

I, the undersigned, do hereby certify that I am the owner (or duly authorised agent for the owner) of the animal described above, that I do hereby give the Veterinarians at “John the Vet” permission to euthanase the said animal and release the said Veterinarians from any liability relating to the euthanasia of the said animal.
Subsequent to euthanasia I would like to (please select one of the following)
__ Make my own arrangements for burial
__ Have “John the Vet” arrange burial
__Have “John the Vet” arrange for cremation

I understand that payment is required prior to euthanasia.

Signed: ________________________________________

Witness: _______________________________________