Date(Required)

Owner Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Client ID #(Required)

Phone Number(Required)

Pets Name(Required)

Patient ID#(Required)

Species(Required)

Breed(Required)

Sex(Required)

Age(Required)

Color(Required)

I hereby state that I am the [legal owner/legally authorized representative of the legal owner] of the Penny and am authorized to make all medical decisions regarding this pet. I have declined any further care for the above pet and am hereby authorizing Veterinary Cancer Care to euthanize the above listed pet.(Required)

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I agree to have Veterinary Cancer Care choose a euthanasia protocol at their sole and exclusive discretion and have had all my questions and concerns regarding this process answered prior to signing this consent. I attest that the above listed pet has not been exposed to rabies, has not bitten anyone, and has not displayed any signs of unusual attitude or aggression in the last 15 days.(Required)

I agree

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 Veterinary Cancer Care to take charge of my pet's remains in accordance with hospital policy, releasing the staff from any and all liability for performing said after death care.(Required)

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I request that this animal’s remains be cared for in the following manner:(Required)

Private cremation with return of ashes. I wish to have my pet individually cremated offsite.

Cremation with no return of ashes. My pet’s remains will not be returned to me.

Home burial. I wish to take my pet’s body home.

I have read and understand this consent.

Signature(Required)

Euthanasia Consent Form

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Make an appointment
with us today!