Euthanasia / Cremation Authorization Form

Euthanasia / Cremation Authorization Form
I certify that I am the owner or the authorized agent for the owner of the pet described above and give Thurman Veterinary Center, the doctors and staff full and complete authority to euthanize my pet. I understand that euthanasia is the act ending the life of an animal in a painless and humane way. Arrangements for aftercare will be based on the wishes of the owner/agent and documented below. I release the above name animal to Thurman Veterinary Center for:
Authorization:
- To the best of my knowledge, the information I have provided on this form is true. I do also certify that my animal has not bitten, seriously scratched or exposed anyone to or has been exposed to rabies within the past 10 days.
- I understand that my wishes will be immediately carried out upon signing this agreement. Fees for these services have been explained to me and will be collected at the time of service.
Pet's Name*
Owner's Name*

First NameLast Name
Owner Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Owner/Agent Signature:*

Clear
Date:

MonthDayYear
Date
Please Elect the Following Procedures*

I choose to retain my pet for burial or self delivery for cremation (Regulations have been discussed)I choose communal cremation (NO ASHES RETURNED BACK TO OWNER) for an additional charge based upon the pets weight.I choose private cremation for the additional charge based upon the pets weight. You will be notified in 4-6 weeks when the ashes have been returned from the crematorium.
I have been made aware of Thurman Veterinary Center Policy on holding memorial items in office. TVC will hold items for 60 days. If items are not picked up, they will be returned to West Coast Pet Memorial for an additional 120 days. If no contact is made, they will then be sprinkled humanely or interred with West Coast Pet Memorial.*

Clear

Extra Services
Clay Paw Print: Clay keepsake featured in a leather case ($48)*

Yes, I would like a clay paw print.No, I decline a clay paw print.
Ink Paw Print ($34)*

Yes, I would like a ink paw print.No, I decline a ink paw print.
Ink Nose Print ($34)*

Yes, I would like a ink nose print.No, I decline a ink nose print.

All of the Doctors and staff at Thurman Veterinary Center are here to help you in any way during this difficult time. Please let us know if you have any questions. We wish you comfort and peace during this difficult time and are so sorry for the loss of your beloved family member.
Should be Empty:

Euthanasia / Cremation Authorization Form

Please choose from the following urns. Your pets remains will be returned in the option chosen below.

Engraving Name Plate

Name Plate Color/Type

Extra Services