New Client Euthanasia Authorization Form

Fees

In-Home Services: $245 (+ travel fee if applicable)

Crematory Options (for pets less than 90lbs): We use All Paws Go To Heaven in Guthrie, Ok.

*Cremation WITH Ashes returned: varies depending on weight of pet (accurate cost will be available when appointment is scheduled)

**Cremation with NO ASHES returned: varies depending on weight of pet (accurate cost will be available when appointment is scheduled)

Cremation bead: $65 (this is a translucent jewelry bead containing some of your pet's ashes) - Provided by All Paws Go To Heaven

Paw print Necklace: $60 - Provided by All Paws Go To Heaven

Urn Necklace: $50 (pendant containing some or your pet's ashes) - Provided by All Paws Go To Heaven

***At this time, we are not able to provide transport for pets greater than 75 pounds. Arrangements will need to be made with your local crematorium prior to services. ***

Owner's Full Name*

First NameLast Name

Additional Owner's Name (Optional)

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

E-mail*

example@example.com

Species*

Pet's Name*

Pet's breed*

Pet's color or markings*

Pet's gender*

Age of Pet*

Pet's current weight (in pounds)*

Reason for Euthanasia*

NoYesYes and has a bite history

Regular Veterinary Clinic

We will notify your pet's regular veterinarian of your pet's passing.

***Please note: We are unable to transport pet's weighing 90 pounds or greater at this time. Arrangements will need to be made directly with the crematorium of your choosing***

I will be responsible for aftercareI would like my pet transported to the crematorium (crematory cost applies)The crematorium will be transporting my petOther

Cremation with NO ASHES returnedCremation WITH ASHES returned

Photos and Information for Included Urn choices

Urn choice if Ashes Returned (included, no additional fee for basic urns) (Mahogany, Birch, Vase, Cedar, Biodegradable, Scatter Bag)

Photos and Information for Special Order Products

Special Order Urn: (if you would like an urn other than what is included in the basic package, additional fees apply) - link below for options

Urn inscription: (if choosing cedar, mahogany, birch or special order urn):

2 lines maximum

RoundHeartNaturalPaw print black (can choose another color for pads to be colored if you prefer)

Glass Memorial bead (made with your pet's ashes): $65Paw Print Necklace: $60Urn Necklace: $50

I, the undersigned, being a person over eighteen years of age, certify that I am the owner (or duly authorized agent) of the above stated animal, and I consent to, and order euthanasia (humane death) to be performed on said animal. I give Dr. Skinner full and complete authority to euthanize said animal in a humane manner and in accordance with the rules and regulations of the establishment. Furthermore, I forever release Dr. Skinner from any and all liability of said euthanasia.

I understand that I assume all financial responsibility for all services rendered.

I do hereby certify that to the best of my knowledge, and belief, the above named animal has not bitten any person or animals during the past 10 days.

Signature*

Today's Date*

Date

Time*

Hour Minutes

AM/PM Option

Please provide your preferred date and time of services below. (pending availability)

Cash (Exact amount needed as I do not carry cash)Credit Card (Square)Scratch Pay

Products