Euthanasia Consent

Euthanasia Consent Form
Client Information
Name *

First Name Last Name
Email *
example@example.com
Primary Phone Number *

Area Code Phone Number
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Patient Information
Pet Name *
Species *

Canine Feline Rabbit
Age *
Date of birth preferred, if known
Breed *
Color *
Sex *

Intact Male Neutered Male Intact Female Spayed Female
Scheduled day of euthanasia *

Month Day Year
I further authorize the attending veterinarian to have the body cremated in accordance with hospital policy and I accept responsibility for the expense incurred. *

Individual Cremation - Your pet's ashes are returned to you. Communal Cremation - You pet's ashes are NOT returned to you. Other - i.e. You will be bringing your pet's body home with you.
Please choose urn (included in individual cremation price) *
We also offer Clay Paw prints.

Each Clay Paw print captures the unique markings of a pet’s paw. A Clay Paw print preserves the memories of special times shared with a pet.

We offer Clay Paw prints in two different colors; Original White and Terra Cotta.

Two sizes are available: Small (~4” diameter, generally recommended for pets less than 50 pounds) $25

Large (~6” diameter, generally recommended for pets greater than 50lbs) $35
Would you like a Clay Paw Print *

Yes No
I would like: *

Small White ($25) Small Terra Cotta ($25) Large White ($35) Large Terra Cotta ($35)
I, the undersigned, do hereby certify that I am the owner (duly authorized agent for the owner) of the animal described above; that I do hereby give the Doctor, his agents, and representatives full and complete authority to humanely euthanize the said animal. I do hereby, and by these presents forever release the said Doctor, his agents, or representatives from any and all liability for so euthanizing the said animal. I do also certify that the said animal has not bitten any person or animal during the last ten (10) days, and to the best of my knowledge has not been exposed to rabies.
Signature *

Clear
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Euthanasia Consent Form

Client Information

Patient Information