Authority for Euthanasia

We are so sorry you are facing this difficult decision. Please fill in the following consent form prior to your visit.
Please Note: Any fields with * are required.

Examples of Cremation Vessels

If you would like your pet’s ashes returned to you after cremation, please indicate what type of vessel you prefer on the form.

Metal Urns

Timber Box

Drawstring Pouch/Scatter Box

Name(Required)

First Last

Email(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date of Euthanasia(Required)

(If this hasn’t been decided yet, please leave blank and we will contact you to arrange.)

I am the

Owner

Authorised Agent

of the animal described below, am above 18 years of age, and I consent to the euthanasia of this animal by a veterinarian at this practice.

Pet's Name(Required)

Species(Required)

Breed(Required)

Colour(Required)

Sex(Required)

Age/Date of Birth(Required)

Microchip Number

If the pet is brought to the practice by an agent of the owner:

Agent's Name(Required)

First Last

Agent's Phone Number(Required)

Agent's Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Digital Signature(Required)

Date(Required)

Aftercare

Please select the option that describes your wishes:

I agree to allow the practice to keep my pet’s body after euthanasia.

I wish my pet’s body to be returned to me/owner.

I request cremation but do not want the ashes returned to me/owner.

I request cremation and the ashes returned to me/owner.

For cremation purposes only - please complete the following:

Please select a cremation vessel(Required)

Metal Urn

Timber Box

Drawstring Pouch/Scatter Box

What would you like inscribed on the plaque?(Required)

Phone

This field is for validation purposes and should be left unchanged.

Authority for Euthanasia

Examples of Cremation Vessels

Metal Urns

Timber Box

Drawstring Pouch/Scatter Box

If the pet is brought to the practice by an agent of the owner:

Aftercare

For cremation purposes only - please complete the following:

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Address

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Hours

Appointment

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