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.

Name *

First

Last

Email *

Phone Number *

Signing this form authorizes CVH to perform humane euthanasia on the pet described below

I, certify that I am the legal owner or duly authorized agent for, the patient, described above, with full and exclusive authority to execute this consent and am over 18 years of age. I do hereby give the doctors, authorized agents, representatives, and staff of this hospital full and complete authority to euthanize the aforementioned pet in a humane manner. I hereby forever release the doctors, staff, authorized agents, or representatives of this hospital from any and all liability for euthanasia and disposing of aforementioned pet. *

Clear Signature

Signature of Owner

Aftercare Choices

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. I request that this animal’s remains be cared for in the following manner: *

Home Burial - I wish to take my pet's body home for burial or for transport to another facility.
Cremation with No Return of Ashes - I wish to have my pet cremated and I do not want ashes returned.
Private Cremation - I wish to have my pet privately cremated and I will select memorial pieces below.
I am unable to make this decision at this time and I choose to authorize a 3 day hold for an additional fee of $65 + the price of communal cremation. If I do not contact CVH with my wishes and pay in full for them at that time, I understand CVH will proceed with the Cremation with No Return of Ashes choice for my pet. If I contact CVH within 3 days, the cost of the communal cremation that you have been charged will be applied to the service you do select, refunded, or applied as a credit on your account. I understand it is my sole responsibility to contact CVH within 72 hours.

If you chose Home Burial, please skip ahead to the State Law section.

If you chose Cremation, please review the sections below about clay pawprint, urn choice, and memorial pieces. While there are countless options, we've prepared a beautiful memorial package for you that is included in the cost of Private Cremation.

Private Cremation Urn Choices (Included/Bundled) - please choose from the following urns which are available to you at no additional charge:

Cedar Memorial Standard Urn
Carved Wood Standard Urn
Remembrance Standard Urn
Decorative Metal Urn - Blue
Decorative Metal Urn - Tan
Scattering Tube with Pawprints - Blue
No Urn - Satin Bag

Engraved Nameplate (Included/Bundled) - if you would like a custom engraved nameplate, please enter what you want on the nameplate below. Write exactly what you want printed including capitalization, nicknames, punctuation, etc. (Only 12 characters are allowed.) Please be mindful that it is challenging to attach a name plate to the metal urns

Line 1 (Only 12 characters are allowed):

Clay Paw Print (Included/Bundled) - do you wish to receive a complementary custom clay paw print at no additional charge?

Yes, please make a pawprint and return it to me
No, I do not want a pawprint

The following items are NOT Bundled and will incur an additional charge

Etching on Metal Urn - $45
Additional Clay Paw Print - $59
Fur Clipping - $23
Artisan Urn (more detail must be provided below)
Custom Memorial Piece (more detail must be provided below)

Custom Etching on Metal Urn - please type exactly what you want here. You will not be sent a proof.

Artisan Urns - if you would like a different urn option, you can choose any from the catalog for the additional cost of the urn. If you'd like an upgraded urn, please write in the name and description, and initial below to indicate acknowledgement of accuracy and increased cost.

Custom Memorial Pieces - in addition to the above urn choices, you may choose from any of the available memorial pieces for an additional cost. Write in your choice below and initial to indicate acknowledgement of accuracy and increased cost.

State Law requires post euthanasia rabies testing of any animal who has bitten people/other animals or been exposed to rabies virus in the last 10 days. *

No Exposure or Bite: I certify to the best of my knowledge the said animal has not bitten any person or animal during the last 10 days and has not been exposed to the rabies virus.
Potential Exposure or Bite: The animal listed above has bitten a person or animal or been exposed to rabies virus in the last 10 days. I understand that said animal must be tested for rabies virus after euthanasia. I understand there is a cost associated with specimen collection for this testing, and I have been given the opportunity to ask more details about what rabies testing entails. The state prefers a full 10 day quarantine prior to euthanasia, and if there are no signs of rabies in those 10 days the state allows post euthanasia rabies testing to be skipped. I have been given the opportunity to complete the 10 day quarantine instead of choosing post euthanasia rabies testing and still choose to proceed with the euthanasia now.

Authorization

I, the undersigned, have reviewed the entire form above and certify it is filled out truthfully and to represent my wishes. I understand by signing below, euthanasia may be performed immediately. *

Clear Signature

Signature of Owner

Losing a family member is very hard. We are here to support you. You can find information about grief counseling and other types of support or tokens of memory in our Grief Room and on our website under Resources - Pet Library - Senior Pets/Quality of Life - Grief Resources. We 3 of 4 have also partnered to provide you access to a 24/7 grief hotline, which can be reached at 1.844.472.9588. Please know that our thoughts and prayers are with you.

Ready to visit?

we know that pets are family.

We believe you deserve compassion, integrity, and collaboration with each step of your pet’s life. Come meet us! We can’t wait to help you and your pet.

Book An Appointment

Have a question?

Contact us

Complete our online form, and we will be in touch with you shortly.



Address

2987 Hunting Dr. NW, Cleveland, TN 37312



Contact

E: [email protected]
P: 423-709-7979
T: 423-799-2937



Hours

Mon: 8 am – 6 pm
Tue: 8 am – 6 pm
Wed: 8 am – 6 pm
Thu: 8 am – 6 pm
Fri: 8 am- 6 pm

** Our hours are set to expand! As soon as we can grow to add more employees and doctors, we will be offering even more hours for your convenience and for your pet’s urgent needs! **

Name *

First

Last

Email *

Phone

How can we help you? *

Coming Soon!

Our appointment booking system is coming soon!