Euthanasia Consent Form in Madison, MS

Everwell Veterinary provides a compassionate and clear euthanasia consent form for pet owners in Madison, MS. Completing this form in advance allows for a more peaceful, uninterrupted in-home experience, ensuring your pet’s comfort and giving your family the space to focus on this important moment.

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Complete Your Euthanasia Consent Form

Please complete the euthanasia consent form prior to your scheduled appointment with Everwell Veterinary. This information helps ensure a respectful, thoughtful process and allows time to review your wishes and your pet’s care plan in advance.

Owner / Authorized Agent *

First

Last

Email *

Pet's Name *

Species *

Breed *

Date *

Authorization and Consent

Authorization and Euthanasia Consent *

I, the undersigned, am the owner (or authorized agent for the owner) of the animal described above. I hereby authorize the veterinarian to perform humane euthanasia. I understand that this procedure will result in the permanent and irreversible death of my pet. To the best of my knowledge, the veterinarian is justified in performing this procedure for humane reasons.

Public Health & Rabies Declaration (Mississippi State Law)

In accordance with the Mississippi Board of Animal Health and state public health guidelines regarding rabies control:

Bite History *

I certify that this animal has not bitten or scratched any person or other animal, causing a break in the skin, within the past ten (10) days.

Rabies Exposure *

I certify that this animal has not been exposed to rabies to the best of my knowledge.

Notice: I understand that if a bite has occurred within the last 10 days, state law may require specific testing or reporting protocols before or after the procedure.

Aftercare Election

Please initial your choice for your pet’s remains: *

Home Burial: I will take responsibility for the private burial of my pet in accordance with local ordinances.
Communal Cremation: My pet will be cremated with other animals; no ashes will be returned.
Individual/Private Cremation: My pet will be cremated separately, and the ashes will be returned to me.

Owner Certification

Signature *

Clear Signature

By signing, I certify that I am at least 18 years of age and have the legal authority to execute this consent. I have had all my questions answered and understand the nature of this procedure.

Today's Date *

Website

Euthanasia Consent Form in Madison, MS

Complete Your Euthanasia Consent Form

Authorization and Consent

Public Health & Rabies Declaration (Mississippi State Law)

Aftercare Election

Owner Certification

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