I, the undersigned, hereby state that I am the [legal owner/legally authorized representative of the legal owner] of the above listed pet and authorized to make all medical decisions regarding this pet. I have declined any further care for the above pet and am hereby authorizing Practice Name * to euthanize the above listed pet.


I agree to have    Practice Name * choose a euthanasia protocol at their sole and exclusive discretion and have had all my questions and concerns regarding this process answered prior to signing this consent.

It is my desire to provide for my pet decent and humane after-death care. I authorize    Practice Name *    to take charge of my pet's remains in accordance with hospital policy, releasing the staff from any and all liability for performing said after-death care. I request that this animal’s remains be cared for in the following manner:

Private cremation with return of ashes, hand carved rosewood urn with engraved brass name plate    Please Specify *  . I wish to have my pet individually cremated offsite. ($249). I understand that if I do not pick up my pet's ashes from DVC within 180 days, they will be returned to the crematorium and scattered in the communal wildflower garden.
OR
Communal cremation with no return of ashes (ashes are scattered in a communal wildflower garden). My pet’s remains will notbe returned to me. ($89)

I have read and understand this consent, have had a chance to ask any questions. *