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(207) 846-6515

EUTHANASIA CONSENT SUPPLEMENT FOR BITING/RABIES ISSUES

YVC CONSENT
EUTHANASIA SUPPLEMENT FOR BITING / RABIES ISSUES

This form is designed to be used along with the YVC Consent for Euthanasia form, as a guide to sorting through the sometimes confusing issues of biting and rabies exposure. The completed form will only be accepted if it is filled out with, or reviewed by a YVC doctor. 

Public health laws require us to ask clients about the rabies vaccination status and whether or not the pet they are presenting for euthanasia has bitten anyone within the previous 2 weeks. 

First, choose statement 1, 2, or 3, whichever one is correct for your pet. Under this statement mark the blank that describes your pet.

1. MY PET HAS NOT BITTEN ANY PERSON OR ANIMAL WITHIN THE PAST 2 WEEKS,

_____ is CURRENTLY VACCINATED AND HAS NO SIGNS OF RABIES. Quarantine and laboratory analysis of the brain are not needed. I consent to euthanasia.  

_____ is CURRENTLY VACCINATED AND HAS SIGNS SUSPICIOUS FOR RABIES. Quarantine is not an option. I consent to immediate euthanasia and laboratory analysis of the brain for rabies.

_____ is NOT CURRENTLY VACCINATED AND HAS NO SIGNS OF RABIES. Quarantine and laboratory analysis of the brain are not needed. I consent to euthanasia. 

_____ is NOT CURRENTLY VACCINATED AND HAS SIGNS SUSPICIOUS FOR RABIES. Quarantine is not an option. I consent to immediate euthanasia and laboratory analysis of the brain for rabies. 

2. MY PET HAS BITTEN, OR MAY HAVE BITTEN A PERSON OR ANIMAL WITHIN THE PAST 2 WEEKS,

_____ is CURRENTLY VACCINATED AND HAS NO SIGNS OF RABIES. Quarantine and laboratory analysis of the brain are not needed. I consent to euthanasia.

_____ is CURRENTLY VACCINATED AND HAS SIGNS SUSPICIOUS FOR RABIES. Quarantine is not an option. I consent to immediate euthanasia and laboratory analysis of the brain for rabies. 

_____ is NOT CURRENTLY VACCINATED AND HAS NO SIGNS OF RABIES. Public health laws require a two-week quarantine for observation for signs of rabies, or immediate euthanasia along with laboratory testing of the brain for rabies. I consent to immediate euthanasia and testing.

_____ is NOT CURRENTLY VACCINATED AND HAS SIGNS SUSPICIOUS FOR RABIES. Quarantine is not an option. I consent to immediate euthanasia and laboratory analysis of the brain for rabies. 

3. MY PET HAS BEEN IN QUARANTINE FOR TWO WEEKS 

_____ and HAS NOT DEVELOPED SIGNS OF RABIES. I consent to euthanasia without laboratory analysis of the brain for rabies.

_____ and HAS DEVELOPED SIGNS SUSPICIOUS FOR RABIES. I consent to immediate euthanasia and laboratory analysis of the brain for rabies. 

OWNER, OR OWNER'S AGENT (sign and print) _________________________________________

                                                                              __________________________________________
DATE ________________

YVC DOCTOR (sign and print)_____________________________________________

                                                   ___________________________________________________

DATE ________________

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Thursday7:306:00
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