Owner's/Agent's Name *

First

Last

Date

Address *

Address Line 1

City

State

Zip Code

Phone *

Email *

Pet's Name *

Species *

Dog
Cat
Other

If Other, please specify

Breed

Color

Age

Weight

Sex *

Male
Female
Neutered Male
Spayed Female

Pet’s veterinarian/clinic

I certify that I am the legal owner duly OR authorized agent for the owner of the animal described above, and do hereby give Dr. Tyler, the Peaceful Goodbyes for Pets, LLC.,and any authorized agents, staff, or representatives full and complete authority to euthanatize and dispose or arrange for cremation of said animal in a humane manner. *

I Agree

I hereby forever release Dr. Tyler, of the Peaceful Goodbyes for Pets, LLC., and any authorized agents, staff or representatives from any and all liability for euthanasia, disposal, cremation and delivery of said animal if applicable. *

I Agree

I do also certify to the best of my knowledge the said animal has not bitten any person or animal during the last 10 days and has not been exposed to rabies virus. *

I Agree

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

Private cremation with return of ashes.
Cremation with no return of ashes. My pet’s remains will not be returned home.
Home burial. I wish to take my pet’s body home.

I further authorize the attending veterinarian to dispose of remains in accordance with hospital policy.

I agree to pay for service rendered.

I have read and understand this authorization. To the best of my knowledge, the information I have provided is true. I understand that my wishes may be carried out immediately upon my signing this agreement. Fees for these services have been explained to me.

Owner or authorized agent’s signature *

Clear Signature

Online Forms

Euthanasia Consent Form

Euthanasia Consent Form

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Phone

Email

Hours

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