Please Note: We will be closed on Thursday, November 28th in observance of Thanksgiving!

Euthanasia Consent

Name: Somerset Animal Hospital
Address: 715 Rivard St., Somerset, WI, 54025, United States
Telephone: 715-247-2324
Price range: $

Please fill out the euthanasia consent form below.

Euthanasia Consent Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit. If this is an emergency, or if your pet needs urgent care, please call us at 715-247-2324 for a faster response.

Pet's Name *

Breed *

Pet's Weight *

Color/Description *

Age *

Sex *

Male
Neutered Male
Female
Spayed Female

As owner, or authorized agent, of animal described above, I hereby consent to, and order, euthanasia ($100-$115 clinic charge) to be performed on this animal. I authorize the attending veterinarian to dispose of the remains as following: *

No cremation. I will be taking the body home for burial.
Group cremation with NO ASHES returned to owner (additional $52).
Individual cremation with ashes returned in cardboard box with velvet bag (additional $135-170).
Individual cremation with ashes returned in wood box (additional $145-185)

I would also like:

Clay paw print (first clay paw is complementary within clinic euthanasia)
Additional clay paw prints ($12 per print).

Please read carefully

I warrant that all representation and statements contained in this form are true and correct *

I agree

I further represent to the best of my knowledge that this animal has not bitten any person or other animal within the past ten (10) days, and is not suffering from or has been exposed to rabies. *

I agree

Owner's Name *

First

Last

Phone *

Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Signature *

Clear Signature

Today's Date *

Euthanasia Consent

Euthanasia Consent Form

For individual cremation please write the following as you would like on the cremation certificate.

Please read carefully

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