Consent for Euthanasia
I hereby give consent for aquisition of a history from my pets veterinary practice and for the euthanasia of my pet
First Name
Last Name
Address with House name/number and Postcode
Additional directions/ Parking recommendations or What.3.word for accurate location at time of visit
Phone Number
Email
Your pets name, age, breed and gender
Your pets guessed weight (esp if over 40kg)
Previous Veterinary Practice
Would you like Home burial, standard or individual cremation?
Select an option
Home burial
Individual Cremation (ashes back)
Standard cremation (no ashes)
If you would like individual cremation, which vessel would you like?
Select an option
Woodland Scatter Box (included)
Scatterpouch (+£20)
Bamboo casket with name plaque (+£25)
Tribute Dog with Bone (+£110)
Tribute Frame in Oak (+£100)
Tribute Sleeping Cat (+£75)
Tribute Memory Teddy Bear (+£75)
Slate Pet Urn (+£65)
If youd like individual cremation, how would you like the ashes returned?
Select an option
To my own vets that provide this (Hayle vets/St Clement vets/Rockview/Vets4Pets)
Pick up from collection box at Alice's home in St Allen, Truro (Free and anytime at your convenience
Have courier service (+£10) - this comes with understood risk associated with postal loss
Hand delivered to your home (+£50)
Would you like a foam pawprint keepsake?
Select an option
Yes
No
Your Signature
*
Clear
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