Forms

Equine Euthanasia Consent Form

(Euthanasia – the humane termination of life)

Name

This field is for validation purposes and should be left unchanged.

Owner

First Last

Address

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Home Phone

Mobile Phone

Patient Name

First Last

Date of Birth(Required)

Age(Required)

Breed(Required)

Sex(Required)

Color(Required)

I, Owner first name Owner last name, am the owner or duly authorized agent of the owner of Patient first name Patient last name. I hereby consent to and request humane euthanasia for Patient first name Patient last name by a veterinarian at Fredericksburg Equine and Small Animal Veterinary Services.

Signature(Required)

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Equine Euthanasia Consent Form