Permission Document

If you are planning to use my services, please download and fill out the following form and send it back to drmimi@pethomeeuthanasia.com or fax it to 623-444-7319.

Euthanasia Authorization Form

(PDF) 163Kb

Note: You will need Adobe Acrobat Reader to view the PDF file. Click the button below to download it for free

If you would like to fill out the interactive version of this form, please fill out the information below and hit 'Submit'.

Authorization Form
Your Name:
Others in Attendance:
Your Address:
Your City:
Your State:
Your Zip:
Your Email:
Your Phone:
Dog/Cat:
Animal Age:
Animal Color:
Animal Breed:
Animal Weight:
Animal Name:
Cremation:
Pick-up:
I certify that I am the owner of (or person responsible for) the animal described above. I give the doctor and his/her assistants complete authority to euthanize this animal in whatever manner they recommend. I understand that the animal will be treated humanely. I release the doctor and his/her assistants from any liability for euthanizing this animal. I also certify that this animal has not bitten any person or animal in the past 15 days and to the best of my knowledge has not been exposed to rabies. I agree to these terms & conditions