Euthanasia Consent Form

Euthanasia Consent Form

  • Client Information

  • Patient Information

  • Authorization for Humane Euthanasia Services

  • I have read and understand this authorization. To the best of my knowledge, the information I have provided is true. I understand that these services will be carried out at the scheduled or agreed upon appointment time. Fees for these services have been explained to me and I am aware payment is due in full prior to, or if authorized by Dr. Kaitlyn Hemsley, at the scheduled appointment time.
  • Electronic Signature Agreement

    The parties agree that the electronic signatures appearing on this form are the same as handwritten signatures for the purposes of validity, enforceability, and admissibility.
  • This field is for validation purposes and should be left unchanged.