River Road - Euthanasia Consent Form

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We understand that this is a profoundly difficult decision. Please know that our team is here to support you with compassion and respect during this sensitive time. We are committed to providing comfort and dignity for your pet's final moments, honoring the special bond you share.

We would like to share these resources with you:

Pet Compassion Careline | 24/7 Complimentary Grief Support
1 (855) 245-8214

Pet Loss Grief Support Resources:
https://www.gatewayservicesinc.com/grief-support

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Owner Information

Owner's Full Name

Mobile Phone

Email

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Address

Street Address

City

State / Province

Postal / Zip Code

Country

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Patient Information

Patient Name

DOB

Age

Species

Breed

Sex

Weight

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I Owner Name , am the owner or duly authorized agent of the owner for the above-named animal, and I hereby consent to and request humane euthanasia for my pet by a veterinarian at this practice.

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Do you wish to be present for the service?

YESNO

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Do you wish to be present for the service?

Yes - In a private exam room.

Yes - I would like to use the private outdoor courtyard.

No - I would not like to be present for the service.

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Do you have your own personal protective equipment (mask and gloves)?

Yes, I will wear my own mask and gloves.

No, I would like RRVH to provide some protective gear for me.

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After CareWe work closely with Heaven's Pets Crematorium to perform cremation for our furry companions. To get more information on their services, please visit their website here.

I wish to take the pet's remains home with me.

I request cremation with the ashes RETURNED to me. (Private cremation service provided by Heaven's Pets - $200-350).

I request cremation but DO NOT want the ashes returned to me. (Communal cremation service provided by Heaven's Pets - $100-175).

I do not want any remains, ashes, or mementos whatsoever. I release ownership and responsibility of the remains and do not wish to be contacted. (Clinic mass through Heaven's Pets - $1.30 per lb)

I have not yet made a decision and request that RRVH hold the body for up to 7 days.

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After-Life Care and Arrangements

If you would like more information on pet cremation and after-life care, or to make arrangements beforehand, please visit one of the following links:

Heaven's Pets Crematorium

Agee's Pet Crematorium

Or feel free to contact our receptionists for more questions: (504) 838-0288.

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Signature* This field is required.

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Date* This field is required.

Date