River Road - Euthanasia Consent Form

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Patient Information
Patient Name
DOB
Age
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Female
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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?If yes, the euthanasia will be performed in our gated outdoor side yard, with proper social distancing and full personal protective equipment. Please wait for a staff member to escort you.
YESNO
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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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