BH 15 Final Wishes and Consent Form

Is your pet

If we feel that your pet’s health is deteriorating, do you give Bonnie’s House consent to take them to the vet?

Please tell us about your pet’s status and their condition.

Please try to give us a baseline on a typical day so that we can tell if they are deteriorating

We will do everything possible to contact you if your pet needs any major medical decisions (including euthanasia), but if we cannot contact you, is there someone else that the vet can call to make decisions for you?

Name

First NameLast Name

Address

Address Line 1

Address Line 2

Town/CityCounty

Post Code

Telephone Number

Please enter a valid phone number.

Alternative Telephone Number

Please enter a valid phone number.

Does this person know that they are named as a decision maker for your pet?

Please talk to this person and check that they are happy to do this before submitting the form.

If your pet passes away peacefully while you are away, would you like us to tell you?

Notes

In the event of your pet’s passing, what arrangements would you like us to make before your return?

Notes

Your pet’s belongings, how can we help?

Notes

Do you agree to be responsible for all fees relating to the wishes detailed on this form, and shall reimburse Bonnie’s House for any out-of-pocket expenses on your return?

Notes

Is there anything else that you would like to tell us?

Customer Signature

Date

Final Wishes and Consent Form

Your details

About Your Pet