Tom Wood, DVM
Animal Hospice and in home Pet Euthanasia
757-373-1863
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Registration
If you would prefer to have the paper work done prior to the visit,  print and fill out the form, and give it to Dr Wood at the time of the visit.

Tom Wood, DVM

 

 

Registration

 

 

 

Owner:________________________________________________________________________

 

Street:________________________________________________________________________

 

City, State, Zip:_________________________________________________________________

 

Phone:________________________________________________________________________

 

 

 

Veterinary Office Where Normally Seen:_____________________________________________

 

How did you find out about us:_____________________________________________________

 

 

 

Pet Name:________________________________________________________________________

 

Color, Breed, Sex, Age:___________________________________________________________

 

 

 

 

Euthanasia Request

            I am requesting that Dr Wood euthanize my pet today for personal or medical reasons. I state that he/she has not bitten anyone within the past 10 days, and that there is not a current rabies quarantine.

 

 

                                                            ______________________________                        ___________                                                                                      Signature                                       date

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