Paws In Paradise Animal Hospital-Euthanasia Consent Form

Owner Name

Address

Mobile Phone

Patient Name

Breed

Sex

Color

I,grant Paws In Paradise Animal Hospital permission to humanly euthanize:

I attest that I am requesting this service on my own volition. I further release Paws In Paradise Animal Hospital, all staff, and doctors of any and all liabilities. I further attest that ________ has not bitten any human in the past ten days.

I wish to (please select one):

1-Take my pet home for burial:

2-Have my pet cremated with no ashes retured($50):

Have my pet privately cremated with ashes returned to me:

Private Cremations with Clay Paw Print ($220):

Private Creamations without Clay Paw Print ($190):

Please select which urn you would like:

*Cedar Standard Urn

*Decorative Metal Urn

*Hand-Carved Roswood Urn

I would like (extra number desired) ______ Clay Paw Print($30/each):

I would like a piece of fur clipping ($20):

I request that Paws in Paradise Animal Hospital hold my pets remains until I have contacted a representative of the hospital with my decision for final body care. Additionally, I understand that this decision must be made within 5 business days from:

If a decision has not been made by this date, I understand Paws In Paradise Animal Hospital reserves the right to proceed with communal of my pet and I will be held responsible for all changes involved. If needed, I can be contacted at the following phone number:

Witnessed Name:

Practice Staff Member:

Date:
MM slash DD slash YYYY