Euthanasia Record Please enable JavaScript in your browser to complete this form.Your Name *Pet Tag Number *Date of Pet admission *Cause of Pet euthanasia *Kindly mention in detail as what could be the cause of the euthanizing of the petInformed the treatment and condition of the pet: *General Condition: Good or DebilitatedVital organs: Stable or abnormalTemperature: Normal or hypothermia or hyperthermiaPain Intensity: Location of the pain on the bodyVomiting: Yes or NoDiarrhea: Yes or NoAppetite and food intake: Good intake or Less intakeUrination: Proper or Improper with yellowish color or blood in urineNote: The call closing should not be as scripted above and should be natural and empathize the reporter in natural conversation. The intention of the call is to provide as much as information to the reporter about the pet.Informed Via? *Phone CallSMS- Owner’s number is switched off or not reachableWhatsApp- Owner’s number is switched off or not reachableGranted permission for the euthanasia? *YesNoIf no, why? *Granted permission for the burial? *YesNoIf no, why? *Was sedation given before anesthesia? *YesNoIf no, why? *Date of Pet euthanasia *Time of Euthanasia *Medicine used to euthanize? *Anesthesia Photo * Click or drag files to this area to upload. You can upload up to 5 files. Serial number of Anesthesia vial *Dosage of medicine *Kindly mention in detail of the medicineTotal minutes/ seconds the pet was euthanized in? *Kindly mention the total time it took to confirm no heart beat from the time injecting the medicine.Euthanasia video * Click or drag files to this area to upload. You can upload up to 15 files. Kindly upload the video of the pet being euthanized by a veterinarian or a compounder. (Video should include from the time of inserting butterfly and till the heartbeat is no more and the same is confirmed by the veterinarian or compounder).Treatment Record (Diagnostic, Medical history, Blood reports etc.) * Click or drag files to this area to upload. You can upload up to 100 files. Any Comments?Submit
