Consent for Aftercare

Consent for Aftercare
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Pets Name (please enter your pets name as you would like it spelled and/or written for services requested below): *
After Care Instructions:
I Request the following aftercare:*

Cremate remains after euthanasia in a communal (non-private) cremation.Cremate remains after euthanasia in an individual (private) cremation and return the ashes to me.
I also request the following:*

Clay Paw Print (one) (white air-dry foam clay in faux leather case)Ink Paw Print (one)Decline any paw printsFur Keepsake Keychain (max of 1 per family) (color may vary)Decline Keepsake KeychainOther
Please allow at least 48 hours for your paw print(s) to dry. You can pick them up any time after this, Monday through Friday, 8:00am until 6:00pm.
I also request the following:*

Terra Cotta Clay Paw Print (one) and fur clipping (will arrive when your pets remains are returned to the Clinic)Ink Paw Print (One)Decline any paw printsFur Keepsake Keychain (max of 1 per family)Decline Keepsake KeychainOther
Please allow at least 48 hours for your paw print(s) to dry. You can pick them up any time after this, Monday through Friday, 8:00am until 6:00pm.
Please see the bottom of this page and select which urn you would prefer (no additional cost):*

Cedar Memorial UrnSerenity Photo UrnHand-Carved Rosewood UrnRemembrance UrnBlue Decorative UrnTan Decorative UrnBio Remembrance UrnScattering Tube
Would you like a name plate at no additional charge?*

NoYes
Would you like this urn engraved with your pets name at no additional charge? *

NoYes
Other services requested at an additional cost (please call for pricing):*

Additional Clay Paw Print (white air-dry foam clay in faux leather case)Additional Ink Paw PrintWood Urn Etching (name only) instead of name plate *Max of 20 characters** This option is not available with the Hand-Carved Rosewood Urn**Additional Engraving (beyond pets name) **Max. of 4 lines with 20 characters per line**No Additional Services RequestedOther
What would you like the engraving to say?*
When your pet's remains have been returned to the clinic, how would you like to be notified?*

CallText
What phone number would you like us to use? *

Area CodePhone Number
I hereby authorize the following for the above referenced patient in a caring manner.

All aboveOther
Signature to authorize the above aftercare.*
Date*

MonthDayYear
Date
Should be Empty: