Euthanasia Consent

Owner Name*

First Last

Owner Email*

Owner Email 2

Owner Email 3

Owner Phone

Owner Address*

Street Address Address Line 2 City State ZIP Code

Patient Name*

Patient Species*

Patient Breed*

Patient Sex*

Patient Age*

PLEASE INDICATE YOUR DECISION FOR CARE OF REMAINS:*

Communal Cremation (No ashes will be returned)
Individual Cremation with Paw Print (Ashes returned)
Return remains for personal care
Help other pets by donating their remains to the Emergency Pet Clinic of Temecula for veterinarians in training
Communal Cremation and Paw Print

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I, the undersigned, am the owner (or duly authorized agent for the owner) of the pet. I hereby consent to and order euthanasia (humane death) to be performed on this animal, forever releasing the Emergency Pet Clinic of Temecula and its staff from any and all liability for performing said euthanasia.

To the best of my knowledge and belief, this animal has not bitten any person during the fifteen (15) days preceding this date.

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 the attending veterinarian and staff to take charge of my pet's remains in accordance with hospital policy, releasing the hospital, veterinarians, and agents from any and all liability for performing said after-death care, with the following stipulations included:

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27727 Jefferson Ave.
Temecula, CA 92590

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