Consent for Euthanasia and Cremation

"*" indicates required fields

Client Name

Client's First Name*

Client's Last Name*

Co-Owner First Name

Co-Owner Last Name

Phone*

Email*

Pet Information

Pet's Name*

Species*

Cat

Dog

Breed*

Sex*

Male

Neutered Male

Female

Spayed Female

DOB / Age*

Estimate if needed

I am the legal owner, legally authorized agent for the owner, or a Good Samaritan responsible for seeking veterinary care for the animal described above, and I have the authority to execute this consent. I have declined any further care for the above pet and am hereby authorizing Companion Animal Hospital to euthanize the above listed pet.

I agree to have Companion Animal Hospital choose a euthanasia protocol at their sole and exclusive discretion. I further agree that I have had all my questions and concerns regarding this process, and alternative options, answered to my satisfaction prior to signing this consent.

I have read and understand this consent and my signature below certifies that I am over eighteen years of age.

Signature*

After-Death Care Consent

It is my desire to provide for my pet decent and humane after-death care, complying with all legal requirements of the area. I authorize Companion Animal Hospital 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 understand that the after-death care may be performed off-site at a location belonging to an outside agent of Companion Animal Hospital’s choosing. When after-death care involves return of cremains, they will be available for pick up at Companion Animal Hospital within 2-3 weeks of the scheduled cremation. I agree that if I, or an authorized agent of mine, does not pick up cremains within 90 days of verbal or written notification of the readiness to be released, that Companion Animal Hospital may handle this abandonment in the best interests of the hospital and I will still be responsible for all fees incurred.

I attest, to the best of my knowledge, that the above listed pet has not been exposed to rabies, has not bitten anyone, and has not displayed any signs of neurologic disease or unusual attitude and/or aggression in the last 10 days.

I request that this animal's remains be cared for in the following manner*

Private cremation with return of cremains. I wish to have my pet individually cremated. One clay paw print included.

Partitioned cremation with return of cremains.

Group cremation with no return of cremains to me. Cremains will be disposed by the cremating agent in a respectful manner that complies with all local legal requirements.

I wish to take my pet’s body home.

I request an additional clay paw print at my cost of $20.00 each*

Yes

Signature*