Euthanasia Record Consent

It is always best when end-of-life decisions can be pre-planned, but too often, we are taken by surprise when our pet’s health takes a turn for the worse.

Please fill out the consent form within 24 hours of your scheduled appointment.

Date*
MM slash DD slash YYYY
Animal Body Weight*
Owner*
Email*
Phone*
Address*
Street Address Address Line 2 City State ZIP Code
Pet's Name*
Breed*
Sex*
Age*
Colors and Markings*
Consent*
I give Dr. Dale Krier and her agents at Creature Comforts Mobile Veterinarian and Home Pet Euthanasia the complete authority to euthanize the above described animal and forever release the said Doctor and her 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 10 days and has not been exposed to rabies.
I, the undersigned do hereby certify that I am the owner (or duly authorized agent for the owner) of the animal described above.
This animal should be:*
- Returned to owner for burial.
- Communal cremation (no ashes returned to owner)
- Semi private cremation (ashes returned to owner)
- Private cremation (ashes returned to owner)
- Other (Describe below)
- Fur clippings
- Clay paw print ($35 each)
Clay Pawprints (#)
Please enter a number from 1 to 15.
Please tell me how many clay paw prints you would like. They are $35 each.
If "other" was chosen, please describe here.
Special requests to Crematorium:
Email
This field is for validation purposes and should be left unchanged.

Creature Comforts
Mobile Veterinary Services

Dr. Dale Krier
Sherman, CT
860-355-0247
drkrier@yahoo.com

euthanasia record consent

Creature Comforts Mobile Veterinary Services

Creature Comforts
Mobile Veterinary Services