Northgate: Authorization to Perform Euthanasia
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Your first and last name: *
Your pet's name: *
The best phone number(s) for us to call you at: *
 I, the undersigned, am the owner/duty authorized agent for the owner of the animal described heron. I verify that said pet has not bitten any person or animal during the last fourteen (14) days and to the best of my knowledge has not been exposed to rabies. I hereby consent to and order euthanasia (humane death) to be performed on this animal forever releasing said doctor and their agent from any and all liability for performing said euthanasia.
It is my desire to provide for my pet decent and humane after-death care, complying with all legal requirements of the area. I authorize the attending veterinarian to now dispose of the remains in the accordance with hospital policy, releasing the hospital, doctor, and any agents from any and all liability for performing said after death-care, with the following stipulations including: NOTE: cost of euthanasia will vary depending on weight of pet. *
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e-Signature (please type your name): *
Today's date. *
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