Fee Summary and Consent
Dr. Maggie MacDonald
Dr. Danielle Chapman
www.CompassionatePetVet.com
512-553-8333
| Client: | Katie Blackwell |
| Address: | 11320 Pardoners Tale Ln, |
| Austin, TX 78748 | |
| Phone: | (512)925-5392 |
| Email: | katie@austinplatinumrealty.com |
| Patient: | Kali |
| Description | Cost | |
| Euthanasia visit | $400 | |
| Cremation (optional) | $275 | |
| Ashes shipping (private only - optional) | $0 | |
| Weekend fee | $0 | |
| Holiday fee | $0 | |
| Total Due | $675 | |
Thank you for entrusting us with the care of your precious Kali.
Please take care,
The Compassionate Pet Vet Team
Consent for Euthanasia
I also certify that my pet, to the best of my knowledge, has not been exposed to rabies, bitten, seriously scratched, or exposed any person or animal to rabies within the past 10 days. I understand that if this statement is not true, it is my responsibility to inform the veterinarian as soon as possible and prior to euthanasia.
All applicable fees have been discussed and agreed upon. I understand that I assume financial responsibility for all services agreed upon and that payment is due when services are rendered.
As a courtesy, I understand that Compassionate Pet Vet will notify the veterinarian/clinic provided by me of the passing of my pet so that records may be updated. If I do not wish this to happen, I will tell the veterinarian during the appointment.
As the owner or authorized agent of the pet named above, I agree to release and indemnify the veterinarian, Compassionate Pet Vet, their officers, directors, agents, employees, and contractors, from any claim, liability, cost, or expense resulting from their reliance on or performance consistent with the directions, declarations, representations, authorizations, and agreements herein. I agree that the veterinarian and Compassionate Pet Vet's liability for negligent acts (of itself or its agents or employees or contractors) is limited to a refund of the relevant fees paid by me.
I have read and understood this document and warrant all representations and statements contained in this form are true and correct.
I certify that I am the owner or authorized agent of the pet named above. I understand that I will be given the opportunity to discuss the process of humane euthanasia with the veterinarian prior to the procedure. As the owner/agent, at the appointed time, I do hereby give Compassionate Pet Vet full and complete authority to perform euthanasia (humane death) on my pet.
Aftercare Consent
There’s nothing more rewarding than helping a deserving pet find its loving forever home. So why not commemorate the occasion? Our free Pet Adoption Certificate Template is the purr-fect way for pet adoption centers to generate beautiful pet adoption certificates for new pet owners. Simply fill in the pet owner’s name, the pet’s name, and the adoption date, and our Pet Adoption Certificate Template instantly turns submitted information into stunning PDFs. You can easily download the PDFs for your records, or print and frame them for proud pet parents.Whether it’s for a cat, dog, bunny, or reptile, our PDF Editor makes creating a well-groomed template simple. Drag and drop elements to add your adoption center’s logo, update fonts and colors, or even include a photo of the lucky little creature! With our free Pet Adoption Certificate Template, you can automatically generate a paw-some keepsake for each and every pet that’s adopted.If you want to create a pet adoption form, please check out the referred page.
Veterinary Hospital Treatment Sheet helps both the hospital and pet owners in understanding and tracking a pet's treatment process. Just like any other hospitals, keeping patient's treatment records is necessary to monitor progress and make sure proper treatment is given. Having a veterinary treatment sheet also helps in planning and evaluating other treatments for the pet, facilitating research and creating a record for the pet's future care. If you are trying to create a treatment sheet and looking for a sample template, then look no further because Jotform offers a Veterinary Hospital Treatment Sheet template you can download, save, edit and print. This Veterinary Treatment Sheet template contains the necessary information for recording and tracking treatment process for your client's pet. It has information such as name of client, date and time, address, contact number, treatment performed, doctor's name, monitoring progress report and many more. This template is editable and allows you to add more information or remove if you need to. Add your hospital's logo or insert images to make it more personalized.
Quickly gather pre-surgery consent for your veterinary practice or pet hospital with this free online Veterinary Surgical Consent Template. Save time and paper and create a custom template to have pet owners go over and sign. Share your consent form via email and collect their online signature, which is then stored in your secure online account.Make this Veterinary Surgical Consent Template your own in seconds with Jotform’s drag-and-drop builder. Upload your logo, choose a new font, add or remove fields, and much more. Once you’re satisfied with the look and feel, your custom consent template will automatically be converted into a PDF document — ready to download, save, and share with your clients. If you want to take your signing process online, create an e-sign document with Jotform Sign.
Whether you’re a veterinarian who treats dogs or cats, organize your records to keep Fido or Felix healthy with Jotform’s Pet Medication Chart Template. It lets you easily monitor each pet’s vaccination records, laboratory tests, and surgeries to make more informed treatment decisions. Simply fill out the attached form on your computer, tablet, or phone, and the template instantly generates pet medication charts as PDFs — easily downloadable or printable for your veterinary records.Give your Pet Medication Chart Template some purr-sonality with Jotform PDF Editor — no coding or design skills needed! Just add medical history fields or update lab test types to create the perfect chart for your needs. With information expertly organized and presented as polished PDFs, your custom Pet Medication Chart Template is a secure way to make sure all pets get the treatment they need.
A Dog Grooming Consent Form is used by pet grooming companies and veterinary establishments to protect both them and their clients. With this easily customizable consent form you can ensure that pet parents are informed about the services you will perform for or on their dog. Collect legally-binding signatures and ensure the safety of all parties involved.Customizing this Dog Grooming Consent Form is easy with Jotform Sign. Use our drag-and-drop form builder to update terms and conditions, change fonts and colors, upload images, set up automated signature collection orders, and more. Once everyone has finished filling out your form, all parties will receive a copy for their records.
Does your animal shelter or pet rescue need a way for individuals to surrender their animals? With Jotform’s Animal Surrender Template, you can build your own animal surrender form for easy, seamless surrenders. Have your audience fill out their name, pet information, reason for surrender, and more. Integrate with payment processors and helpful widgets to make your online form even more easy-to-use.Cater to your shelter or rescue’s needs by customizing your Animal Surrender Template to your liking. Include your organization’s personal details, policies, and terms. You can also make cosmetic changes to your form like adding additional signature fields, changing fonts and colors, uploading logos and images, and more. Make the surrender process the easiest it can be with Jotform. If you want to take your signing process online, create an e-sign document with Jotform Sign.
These templates are suggested forms only. If you're using a form as a contract, or to gather personal (or personal health) info, or for some other purpose with legal implications, we recommend that you do your homework to ensure you are complying with applicable laws and that you consult an attorney before relying on any particular form.
