Euthanasia Consent Form - Mission Valley Veterinary Clinic

Date(Required)

Name(Required)

First Last

Address(Required)

Street Address City State ZIP Code

Phone(Required)

Pet's name(Required)

Breed(Required)

Sex(Required)

Male

Female

Age(Required)

Color/Markings(Required)

I, the undersigned, do hereby certify that I am the owner (or duly authorized agent for the owner) of the animal described above.

Intial Below(Required)

I give the doctors and the agents at Mission Valley Veterinary Clinic the complete authority to euthanize the above described animal and forever release the said Doctor and the agents from all liability for euthanizing the said animal.

To the best of my knowledge and belief, this animal has not bitten any person during the previous fifteen (15) days, and has not been exposed to rabies.

Handle the payment before the procedure

I wish to have my pet's body handled in the following manner:(Required)

Return, I will arrange for after care.

Communal Cremation (Country Burial, no ashes returned)

Private Cremation with ashes returned to me

Inscription: Laser engraving: 28 character limit per line. Engraved plate: 20 character limit per line(Required)

Laser Engraving

Laser Brass Plate

Optional Private Cremation choices (additional charge for each service):(Required)

Laser Paw print

Laser Custom Photo

Laser Breed Sketch

A complimentary scattering of your pets ashes will be done if your pet’s remains have not been picked up within 6 months.

Signature of an Owner or Agent(Required)

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