ABQ Mobile Vet Euthanasia Consent Form

Date*

Email*

example@example.com

Owner Name*

First NameLast Name

Patient Name*

Patient Age/Color/Weight*

Species*

DogCatOther

Previous Veterinary Clinic*

For notification purposes (if none please enter NA)

Reason/s for end of life care*

Because we are a mobile veterinary practice and drive times may vary, please expect our team to arrive up to 30 minutes before or after your scheduled appointment time. For example, if your appointment is scheduled at 8:30AM, our team may arrive anytime between 8am and 9am.*

Yes, I consent to a one hour window of arrival

Body Aftercare Options*

Private Cremation 200.00+tax (ashes returned)Communal Cremation 120.00+tax (ashes NOT returned)Home Burial (done by owners, no charge)

Urn Selection (included in cost, private cremation ONLY)

Wood UrnCeramic UrnCardboard Scatter Tube

Paw Print? (Provided by Best Friends with cremation service for $40, pictured right) **Pawprint not included for home burial option***

YesNo

I, the undersigned, do hereby certify that I am the owner (or duly authorized agent for the owner) of the animal present today. I confirm that I do hereby give ABQ Mobile Vet. their agents, servants, and representatives full and complete authority to euthanize the said animal in whatever manner the said DVM, their agents, servants, or representatives shall deem fit. I agree to the trip fee charge of 65.00 to 90.00 depending on my location. I also agree to the euthanasia charge of 262.50 and any additional taxes these fees may incur. I do hereby, and by these presents forever release the said DVM, their agents, servants, 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 fifteen (15) days and to the best of my knowledge has not been exposed to rabies.

Signature*

ABQ MOBILE VET

Please note: