If the equine is insured, it is the responsibility of the owner/agent to inform the insurance company of the euthanasia and have them contact Charleston Equine Clinic for further details. If the insurance policy states that the treating veterinarian must contact the insurance company before euthanasia, please provide the requested information below. If a post mortem exam is required for insurance purposes, I hereby grant permission to the treating veterinarian to perform said exam and agree to pay all costs related to the post mortem exam.

I, the undersigned, certify that I am the owner or duly authorized agent for the owner of the animal described above. I hereby give the doctors, agents, servants, and representatives of Charleston Equine Clinic full and complete authority to humanely euthanize said animal in a humane manner. Unless otherwise agreed upon, disposal of the body of said animal is left to the judgement of the veterinarian. I agree to pay all costs incurred in this procedure, including disposal costs. I also hereby, by signing this form, forever release the doctors, agents, servants, and representatives of Charleston Equine Clinic.