Online Forms

Euthanasia Consent Form

Thank you for choosing Creekside Veterinary Hospital. Please fill out this form as completely and accurately as possible before your scheduled appointment with us. We are here for you during this difficult time.

Please select one of the following *

New Client
New Pet
Established Client
Established Pet

Date *

Phone Number *

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Pet's Name *

Breed or Color *

Age: *

Species (dog, cat, etc) *

I, the undersigned, certify that I am the owner (or an authorized agent for the owner) of the above. I request, consent to, and order euthanasia to be performed on the above animal. To the best of my knowledge, and belief, this animal has not bitten any person or animals during the past 15 days and has not been exposed to rabies. I give Creekside Veterinary Hospital full and complete authority to euthanize and dispose of the said animal in a humane manner and in accordance with the rules and regulations of the establishment. Furthermore, I forever release the doctor, representatives, and business from any and all liability of the said euthanasia. I also understand that the Doctor on duty at CVH at the time of my appointment does reserve the right to decline euthanasia if they do not feel it is in your pet’s best interest. *

Signature of Owner

Signature of Witness *

Please indicate your decision for aftercare below *

I will take my pet home for burial or personally deliver to a crematorium after euthanasia
I elect Communal Cremation, I understand I will NOT get memorial ashes returned
I elect Private Cremation, with memorial ashes returned to CVH typically within 1-2 weeks and I will choose memorial pieces at the time of our appointment

We offer a variety of beautiful urns and other memorial pieces for cremated pets. A complete list of options can be viewed here.

Losing a family member is very hard. Please know that our thoughts and prayers are with you. You can find information about grief counseling and other types of support or tokens of memory in our Grief Room. With respect, The Creekside Team

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Online Forms

Euthanasia Consent Form

Euthanasia Consent Form

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