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At Home Pet Euthanasia
Geriatric Care for Dogs and Cats
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Redmond Oregon Home Pet Euthanasia
La Pine Oregon Pet Euthanasia
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Euthanasia Consent Form
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Home
About
Services
At Home Pet Euthanasia
Geriatric Care for Dogs and Cats
Hospice Care for your Pet
Palliative Care for Dogs and Cats
Service Areas
Bend Oregon Mobile Pet Euthanasia
Redmond Oregon Home Pet Euthanasia
La Pine Oregon Pet Euthanasia
Pricing
Client Forms
New Client Form
Euthanasia Consent Form
FAQ
Contact
Euthanasia Consent Form
Consent for in-home euthanasia services
Owner Information
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Referral Source
*
Google
Friends/Family
Veterinary Referral
Other
Pet Information
Pet Name
*
Type of Pet
*
Cat
Dog
Gender
*
Female
Male
Breed
*
Age
*
Color
*
Estimated Weight
*
Regular Vet (if applicable)
Consent
I, the undersigned, do hereby certify that I am the owner (or duly Authorized Agent for the owner) of the pet described above. As the owner or agent for this animal, I do hereby give Sunset Veterinary Services and Representatives full and complete authority to perform euthanasia services for said pet in whatever manner Sunset Veterinary Services and it's representatives shall deem fit.
*
I confirm
I decline
I do, also certify that the aforementioned pet has not bitten any person or animal during the last ten (10) days, and to the best of my knowledge has not been exposed to rabies.
*
I confirm
I decline
I do, hereby, forever release Sunset Veterinary Services, its Agents and Representatives from any and all liability for services rendered such as the euthanization of the referenced pet. Arrangements for the aftercare will be based on the wishes of the owner on behalf of the owner and documented below.
*
I confirm
I decline
Post Care Services
Aftercare
*
Private cremation with ashes returned. Sunset Veterinary Services will transport your pet for cremation.
Communal cremation with no ashes returned. Sunset Veterinary Services will transport your pet for cremation.
I choose to retain my pet for home burial.
Sunset Veterinary Services will transport your pet for cremation.
Memorials
*
Ink Paw Print
Clay Paw Print
Ink Nose Print
None
Date
-
Month
-
Day
Year
Date
Signature
*
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