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Pet Euthanasia
New Clients / Consent Form
Pricing
FAQ
About Us
Contact Info

New Clients / Consent Form

New Clients / Consent Formadmin2024-09-25T11:37:11-04:00

Please submit the following consent form at least 24 hours prior to your scheduled appointment.

Euthanasia Consent Form

Name(Required)

First Last

Spouse/Partner’s Name (if applicable)

First Last

Email(Required)

Phone(Required)

Address(Required)

Street Address City State ZIP Code

Address you would like the euthanasia performed (if different than permanent address)

Street Address City State ZIP Code

Previous Veterinary Clinic (to inform of pet's passing)

How did you hear about Serenity Mobile Veterinary Care?

Vet Office

Internet

Friend

Other

If other, please specify

Patient Information

Pet's Name(Required)

Age(Required)

Sex(Required)

Breed(Required)

Color(Required)

Weight (estimated)(Required)

If your pet is over 60 pounds, will there be someone there to help get the pet to the car in case Dr. Krystle doesn't have help that day?

Yes

No

Pet’s Underlying Medical Condition(s)/Diagnosis

If applicable, this can help us determine the safest/most effective sedation for your pet

Additional comments (ex. any special needs, religious requests or situations in the house Dr. Krystle should be aware of?)

I certify that I am the owner or authorized agent of the owner for the above animal. In being the owner/agent for this animal, I do hereby give Serenity Mobile Veterinary Care full and complete authority to perform euthanasia services. Arrangements for aftercare will be based on the wishes of the owner/agent and documented below. If home burial is selected, owner/agent agrees to abide by all local rules and regulations regarding safe pet burial. To the best of my knowledge, the information I have provided on this form is true. I do also certify that this animal has not bitten, seriously scratched, or exposed anyone to rabies within the past 10 days. Fees for these services are understood or have been explained to me and will be collected prior to time of services.(Required)

I have read and understood the above consent form and my signature below indicates such

I do not understand or consent to the previous statement.

Consent Signature(Required)

I further authorize the attending veterinarian to have the body cremated in accordance with hospital policy and I accept responsibility for the expense incurred.(Required)

Individual Cremation - $550+ - Your pet’s ashes are returned to you.

Communal Cremation - $425+ - Your pet's ashes are NOT returned to you.

Other/No Cremation - $325+ - i.e., You have a nice spot picked out to bury your pet.

Please select which urn you would like.(Required)

Wooden Acacia Urn

Silver Urn

Foldable Decorative Box

Eco-Friendly Heart Shaped Urn

Eco-Friendly Cylindrical Urn

Are you interested in having your wooden urn engraved? (Additional $15-$20)(Required)

Yes

No

Your pet's name, symbols, and/or verbiage of your choosing may be engraved on your urn. Different fonts/styles available.

Please provide a detailed description of what you would like engraved on your urn.(Required)

Please include Name, Font, Symbols (if desired) and layout if you want multiple lines of verbiage. Please visit Pricing page for examples and details.

Would you like a complimentary clay paw print keepsake?(Required)

Yes

No

Please select your paw print clay color from the choices below:(Required)

Natural Clay White

Violet

Moss (Dark Green)

Pacific (Dark Blue)

Seal (Dark Gray)

Fawn (Tan)

Flamingo (Pink)

*Please visit Pricing Page to view color swatches*

Would you like us to collect a complimentary lock of fur for you as a keepsake?(Required)

Yes

No

Email

This field is for validation purposes and should be left unchanged.

CAETA Certified: Peaceful End-of-Life Veterinarian Seal

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Our Mission

Our mission is to honor pets and families by offering compassionate in-home euthanasia, letting pets pass peacefully and with dignity at home.

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