Euthanasia Consent Form

Date

Name*

First NameLast Name

Patient Name*

Primary Phone Number*

Area CodePhone Number

It is our priority to allow your cat to pass as painlessly and with as much dignity as possible. Your cat will be given a sedative injection and/or pain medication prior to the administration of the euthanasia injection. Our goal is to treat you and your cat with the utmost compassion and respect during this difficult time.

Euthanasia Appointment: (select one)*

I do wish to be present with my cat for the duration of the euthanasia. I understand the above COVID-19 policies.I only wish to be present with my cat for the initial sedation. I understand the above COVID-19 policies.I do not wish to be present with my cat for the initial sedation or euthanasia. Please be assured that your cat will be treated with the utmost kindness and compassion.

Memorial Request: In honor of your cat, we do offer complimentary memorial items. (select all that apply)*

I would like fur clippings. Fur clippings are placed in a glass vial. If you are choosing a private cremation, fur clippings will be provided by the cremation company.I would like a clay pawprint. If you are choosing a private cremation, a clay pawprint will be provided by the cremation company. This will be returned at the same times as the ashes.I do NOT want either fur clippings or a clay pawprint.

Arrangement Options: (select one)*

I choose to have my cat cremated WITHOUT ashes being returned to me. (General Cremation).I choose to have my cat cremated and ashes returned. (Private Cremation). Please also select an urn option below.I will make my own arrangements after euthanasia. Your cat will be placed in a complimentary burial casket.

Private Cremation Options: Your cats ashes will be returned to the clinic in approximately 2-5 business days.

Cedar (Wood) Memorial Urn (No additional fee)Remembrance Urn- Darker wood urn with a latch on the lid (No additional fee)Hand-Carved Rosewood Urn- rectangle shaped with decorative design on lid (No additional fee)Decorative Metal Urn- Traditional Urn shape BLUE in color (no additional fee)Decorative Metal Urn- Traditional Urn shape TAN in color (no additional fee)Scattering Tube- Cylindrical Shaped Urn with removal top for scattering of ashes (no additional fee).Upgraded Urn - A staff member will further discuss your wishes. Additional Fees Apply.

Consent for Euthanasia: I, the undersigned, do both certify that I am the owner or duly authorized agent for the owner of the animal described above, request, consent to and order humane euthanasia to be performed on said animal. I do hereby give Dr. Reagan or Dr. Vani (agents and representatives) full and complete authority to humanely euthanize my pet. I do hereby release the veterinarian, representatives and CATS VETERINARY from any and all liability for the euthanasia and disposal of my animal. I understand that euthanasia is an act of ending the life of the animal in a painless way to prevent unnecessary suffering. I also certify that to the best of my knowledge the said animal has not bitten or injured any person or animal during the last ten (10) days, and to the best of my knowledge has not been exposed to rabies. I further understand that I assume financial responsibility for all services rendered. *

Cats Veterinary

43727 Gratiot

Clinton Township, MI 48036

Dr. Christy Reagan

Dr. Janette Vani

586-463-9550

Euthanasia Consent Form

Euthanasia Policy