Euthanasia Consent

Please fill out the euthanasia consent form below, and a member of our team will get back to you shortly. If you have any questions, please feel free to contact us.

APPOINTMENT

Euthanasia Consent Form

We are so sorry you are facing this difficult decision. Please fill in the following consent form prior to our visit. Please note any fields with * are required.

Owner's/Agent's Name *

First

Last

Date

Address

Address Line 1

City

State

Zip Code

Phone *

Additional Phone

Email *

Pet's Name *

Species *

Dog
Cat
Other

If Other, please specify

Breed

Color

Age

Weight

Sex *

Male
Female
Neutered Male
Spayed Female

How did you hear about our services?

Please list all veterinarians and pet care professionals who have seen your pet within the last 3 years:

File Upload

Click or drag a file to this area to upload.

After Care Arrangement Options

Please select an arrangement *

I will handle and take full responsibility for all after care arrangements myself. I am aware of any applicable laws and regulations regarding the burial of a pet’s body and understand caution should be taken when disposing of animals euthanized with drugs/chemicals.
I wish to have Carolinas Veterinary Care Clinic arrange for my pet's aftercare (you must select one of the options seen below):
I wish to have a separate cremation service arrange for my pet's aftercare.

I wish to have Carolinas Veterinary Care Clinic arrange for my pet's aftercare (you must select one of the following): *

Communal Cremation (no ashes returned)
Private Cremation with ashes returned to me

I certify that I am the legal owner/duly authorized agent for the owner of the animal described above, and do hereby give Carolinas Veterinary Care Clinic and any authorized agents, staff, or representatives full and complete authority to euthanize and handle after-care of said animal in a humane manner. I hereby forever release and hold harmless Carolinas Veterinary Care Clinic and any authorized agents, staff, or representatives from any and all liability for euthanasia and disposal of said animal. *

I have read and understand

Dogs, Cats and Ferrets: To the best of my knowledge, the dog, cat, or ferret described above has not bitten, scratched, or otherwise potentially exposed any person or other animal to rabies in the past ten (10) days. Other Species: To the best of my knowledge, the animal described above has not bitten, scratched, or otherwise potentially exposed any person or other animal to rabies in the past thirty (30) days. I understand that if the animal described above has bitten or otherwise potentially exposed any person within the time specified, a rabies test must be performed. *

I have read and understand

I understand that euthanasia is the act of ending the life of an animal in a painless way to prevent any unnecessary suffering. To the best of my knowledge, the information I have provided is accurate and complete. I understand that my wishes may be carried out immediately upon my signing this agreement. Fees for these services have been explained to me, and I assume full responsibility for all charges applicable to such services. I have carefully read and fully understand the foregoing provisions. *

I have read and understand

Owner/Agent Signature *

Clear Signature

Date *

Is the above signature Owner or Agent? *

Owner
Agent

Witness Signature

Date

Simply the best for your pet.

Our goal at Carolinas Veterinary Care Clinic is to help pet’s live long, happy and healthy lives. We believe that a key element to healthy pets is a great relationship with your veterinarian.

APPOINTMENT

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Address

10110 Northcross Center Cr #100
Huntersville, NC 28078

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Contact

704-439-0600
hospital@carolinasvetcare.com

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Hours

Mon - Fri: 8am – 6pm
Sat & Sun: Closed
Please call for our grooming schedule.

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CVCC is pleased to offer home delivery of your pets medications through our online store available 24 hours a day 7 days a week.

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Have a question?

Please complete the form below and a member of our team will get back to you as quickly as possible. If you need immediate assistance, please call us directly at 704-439-0600.

Name *

First

Last

Email *

Phone

How can we help you? *

Phone