Euthanasia

1
Your Name* This field is required.
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2
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3
Email
example@example.com
4
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5
Patient Information* This field is required.
Name
Breed
Color
Age or Date of Birth
Spayed or Neutered (Yes or No)
Weight
6
I, the undersigned, do hereby certify that I am the owner (duly authorized agent for the owner) of the animal described above; that I do hereby give All Creatures Animal Clinic, his agents, servants, and representatives full and complete authority to euthanize the said animal in whatever manner the said Doctor, his agents, servants, or representatives shall deem fit.* This field is required.
YESNO
7
I do hereby forever release the said Doctor, his agents, servants, or representatives from any and all liability for so euthanizing the said animal.* This field is required.
YESNO
8
I certify that the said animal has not bitten any person or animal during the last fifteen (15) days, and to the best of my knowledge has not been exposed to rabies.* This field is required.
YESNO
9
I further authorize the attending veterinarian to have the body cremated in accordance with hospital policy and I accept responsibility for the expense incurred. I understand that AquaCrossings, the company we use for cremation, will reach out to us directly by email and/or phone to verify necessary aftercare decisions (cremation, paw print, memorial products). I understand that charges for these services/items are not being charged by All Creatures Animal Clinic. These required charges will be charged by AquaCrossings when selections are verified.* This field is required.Please select one:
Communal Cremation - I do not want my pet's ashes back.
Individual Cremation - I would like my pet's ashes back.
Other - (e.g. I will be bringing my pet home)
After-care options
10
Signature* This field is required.
Clear
11
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