Euthanasia Consent Form

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Fill out the online form

For the performance of euthanasia, we would like to ask you to complete the form on this page as fully as possible and sign it digitally.

Euthanasia consent form

Date

Owner details

Salutation

First name

Last name

Street name + house number

Zip code

Place of residence

Country

Horse details

Horse name

Breed

Birth date

Chip number

General

SIGNATURE OF OWNER

I, the undersigned, certify that I am the owner (or an authorized agent for the owner) of the above stated animal, and I consent to, and order euthanasia to be performed on the said animal.

I provide veterinarian (mention name in next field) or his/her representative, full and complete authority to euthanize and dispose of the said animal in a humane manner and in accordance with the rules and regulations of the establishment.

Agree

Name of veterinarian or substitute

Furthermore, I forever release the doctor or representatives from any and all liability of the said euthanasia.

Agree

Also applicable:

The mortal remains will be picked up by the company Rendac.

The horse is destined for cremation

Autopsy is required

Comments

General terms

I have read the General Terms and Conditions and Addendum and agree to them.

Please remind us that the bill must be paid at the reception immediately after the treatment. This can be done by Bancontact/debit card (preferred), credit card (VISA/Mastercard), or cash. Please contact us if you are not present yourself and would like to pay via a payment link (= instant payment).

If you are human, leave this field blank.