Euthanasia and Disposition Consent Form

Owner's Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Mobile Phone Number*

Please enter a valid phone number.

Second Contact Number

Please enter a valid phone number.

Email*

example@example.com

Pet's Name

Pet's Breed

Type of Animal

DogCatOther

Approximate Age*

Approximate weight*

Sex*

MaleFemale

Reason for euthnasia*

We typically see appointments Monday through Friday from 9-4. If we have not already arranged a date and time for your appointment, we will send you a link to our schedule. We know that there are times when things progress quickly and you need an appointment urgently. We will try and accomodate these to the best of our abilities. Please text 843-907-2138 if this appointment is needed within 24 hours or if there is a time you need that is not available. Cost for our services is $300 for cats and $325 for dogs any aftercare arrangements will be in addition to this fee.

If you do not already have a scheduled appointment please click send me a link below and I will send you a link to my calendar so you can schedule when you are ready. You can also find a link to my calendar and book your appointment from my website brassvetcare.com

Please send me your calendar link.

Pet's regular veterinarian. If you are not local or do not have one please type None.*

If you have a regular veterinarian, would you like us to notify them of your pet's passing?*

YesNo

Body disposition- Please select only those that apply

Private cremation with Good Shepherd Pet Services (Ashes will be returned to you) Brass Veterinary Services will transport the body and arrange for return of cremains. Additional fees apply and are based on the weight of your pet. This service starts at $295 and increases based on weight. A carved, engraved wooden urn and clay paw print is also included.Communal cremation with Good Shepherd Pet Services. Ashes will NOT be returned to you, but will be spread in a memorial garden. This service is $100 for dogs under 100 lbs. and $165 for dogs over 100 lbs.My pet is over 50 lbs and I am able to help carry a stretcher after the appointment if Brass Veterinary is helping with my aftercare arrangements. If you are having cremation services and do not check this box we will bring an assistant with us to your appointment.I will arrange my own aftercare with another pet cremation company in the area. If you are arranging for them to pick-up make sure it is at least 30 minutes after Brass Veterinary Services arrival time.Home burial. If you choose to bury your pet at home, know that it is your responsibility to contact local city/county for regulations. South Carolina law states "when buried, an animal shall be put not less then three feet under the ground."I would like a body bag for my use for home burial (included in cost of euthanasia). This bag is purposely designed not to put wildlife and other pets at risk.

Private Cremation with Good Shepherd includes a clay paw print, a carved wooden urn and up to 2 lines of engraving with a laser paw print. Please enter what you would like on LINE 1: blanks . LINE 2: blank . Other specialty urns and products are available at retail cost at www.goodshepherdpet.com

If you are having Private Cremation arranged by Brass Vet Services, would you like an extra clay paw print for $30? For communal cremation arranged through Brass Vet Services can also request a clay paw that will be sent to you.

YesNoNot sure

Please choose one or more of the following payment methods. If we are helping with aftercare I will send the cost of this service. If paying cash, please have exact change as I do not carry cash. If paying by credit card, Venmo, or Zelle an invoice will be sent to your email or phone and payment will need to be received before the scheduled appointment time.*

CashCredit cardVenmoZelle

I certify that I am the owner or authorized agent of the owner and that I am at least 18 years of age, for the above-named animal and hereby give Brass Veterinary Services and its Doctors complete authority to perform euthanasia (humanely terminate life) of my pet. Arrangements for aftercare will be based on the wishes of the owner/agent and documented above.

To the best of my knowledge, the information I have provided on this form is true. I also certify that this animal has not bitten any human or other animal within the last 10 days. (This question is in regards to Rabies law for SC.)

Signature

Drugs Used:

Appointment notes