Veterinary Medical Center of Fort Mill is here for you during this difficult decision. Please fill out the Euthanasia Authorization Form to help us prepare for your visit. Client Name(Required) First Last Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone(Required)Email(Required) Pet's Name(Required) Species(Required) Dog Cat Breed(Required) Sex(Required) Male Male (neutered) Female Female (spayed) Color(Required) Weight(Required) I, the undersigned, do hereby certify that I am the owner or duly authorized agent for the owner of the animal described above, that I do hereby give the doctors of Veterinary Medical Center of Fort Mill permission to euthanize and dispose of said animal in whatever humane manner the doctors of Veterinary Medical Center of Fort Mill, their agents, servants or representatives deem appropriate. I also release the doctors, Veterinary Medical Center of Fort Mill, their agents, servants, and representative from any and all liability for so euthanizing and disposing of said animal. I do also certify that to the best of my knowledge the said animal has not bitten any person or animal during the last fifteen (15) days and has not been exposed to rabies.Disposition of remains: General Cremation - $70 paid to VMC Private Cremation - $275 paid to Faithful Companion directly by pet owner Pet owner will take pet after euthanasia. Private Cremation Additional Items Add Clay Pawprint - $40 Paid to Faithful Companion directly by pet owner Engraving for Private Cremation/Special Request Signature(Required)Date(Required) MM slash DD slash YYYY CAPTCHAEmailThis field is for validation purposes and should be left unchanged.