Euthanasia Consent Form

"*" indicates required fields

Owner & patient details

Owner*

Address*

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

Phone*

Pet Name*

Species*

Breed*

Weight*

Age or Birthdate*

Sex*

Colour*

What is the date of your appointment?*

Euthanasia Consent

Aftercare

Aftercare Requested*

Private Cremation Urn Choice*

If you have chosen Private Cremation above you can also choose to have your pet's ashes placed in an urn prior to pick up, at an additional cost. Please indicate your urn choice.

Wooden Box Name Plate Inscription

If you selected a private cremation with a wooden box urn, you can also request a brass nameplate ($30) be adhered to the urn. Please indicate below what you would like inscribed on the nameplate. Please be advised inscriptions must be short, typically they are pet name and years of birth/death.

Would you like pawprints (ink stamped on paper)?*

Yes

Owner's Consent

Signature*

Owner & patient details

Euthanasia Consent

Aftercare

Owner's Consent

Weste Animal Hospital

Contact Us

Emergency Line

Euthanasia Consent Form

Need a Prescription Refill?

Owner & patient details

Euthanasia Consent

Aftercare

Owner's Consent