Euthanasia Consent Form

Owner's Contact Information

Patient's Contact Information

I, the undersigned, do hereby certify that I am the owner (or duly appointed agent of the owner) of the animal described above; and that I do hereby give Dr.Colin Scruton, his agents and representatives, full and complete authority to destroy the aforementioned animal in such a manor as is deemed necessary.

I further certify that this animal has not bitten any person or animals during the last fifteen 15 days, and to the best of my knowledge has not been exposed to Rabies.

I hereby release Dr. Colin Scruton, his agents and representatives, from any and all liability for said animal.