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.