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Pet's Name(Required) Species(Required)DogCatBreed(Required) Weight(Required) Color(Required) Age(Required) I, the undersigned, am at least 18 years old, and I am the owner / duly authorized agent for the owner of the animal described herein. I hereby consent to and order euthanasia (humane death) to be performed on this animal forever releasing said doctor, hospital, and all agents from any and all liability for performing said euthanasia. It is my desire to provide for my pet decent and humane after-death care, complying with all legal requirements of the area. I authorize the attending veterinarian to now dispose of the remains in accordance with hospital policy, releasing the hospital, doctor and agents from any and all liability for performing after-death care, with the following stipulations included:(Required)Please select oneI will handle and take full responsibility for all aftercare arrangements myself. I am aware of any applicable laws and regulations regarding the burial of a pet’s body and understand caution should be taken when disposing of animals euthanized with drugs/chemicals.I have arranged to have a cremation service handle my pet’s aftercare.I verify that the above stated pet has not bitten any person or animal during the last fourteen (14) days and to the best of my knowledge has not been exposed to rabies.(Required)
Payment is due in full at the time that services are performed. We accept Cash, Check and Credit payments. We neither extend credit, nor bill for services. All open invoices are sent to collections after 45 days unless prior arrangements are made.(Required)SignatureDate(Required)
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NameThis field is for validation purposes and should be left unchanged.