Euthanasia and Disposition Consent Form II

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.Format: (000) 000-0000.

Second Contact Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Pet's Name

Pet's Breed

Type of Animal

Other

Approximate Age

Approximate weight

Sex

My pet has a history of aggression or has a bite history

Reason for euthanasia

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 reach out to 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 $325 for cats and dogs under 10 pounds $375 for dogs over 10 pounds. Any aftercare arrangements will be in addition to this fee.

Appointment - Please choose the best way for us to contact you if you need to schedule an appointment.

Please select the days of the week that work for you and time of day you would prefer. This will help us to find an appointment day and time that works best.

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?

Body disposition- Please select only those that apply

I am able to help transport my pet to Dr. Brass's vehicle if I am having them arrange aftercare. Due to Dr. Brass being injured she is limited in her ability to carry pets over 20 pounds. If Brass Veterinary is helping with aftercare arrangements, we may need you to help transport your pet to our vehicle. We have a stretcher for heavier pets. **If you are having cremation services and do not check this box we will bring an assistant with us to your appointment. This may require more flexibility in scheduling.***

Private Cremation includes a clay paw print, a carved wooden urn and up to 2 lines of engraving with a laser engraving of your pet's paw print.
Please enter what you would like on LINE 1: blanks . LINE 2: blank . Text is limited to pet's name and dates at this time. If you do not fill this in only your pet's name and paw print will appear on the urn.

If you are having Private Cremation arranged by Brass Vet Services, would you like an extra clay paw print for $40? For communal cremation arranged through Brass Vet Services you can also request a clay paw that will be sent to you.

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 the day before your appointment to your email. Payment will need to be received before the scheduled appointment time if not paying cash.

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