Euthanasia Authorization Form

I, the undersigned, do hereby certify that I am the owner, or dually authorized agent for the owner, of the animal described above. I do hereby give the doctors of Aliante Animal Hospital the complete authority to humanely euthanize my pet. I request that Aliante Animal Hospital make arrangements for the final disposition of the remains of my pet as noted below. I do hearby release Aliante Animal Hospital, their staff, and representatives from any and all liability for euthanizing and handling the arrangements for my pet.*
YesNo

*Indicates Required Field

Pet Owner Information:

Owner's Name*

Owner's Phone Number*

Owner's Email (recommended)

Pet Information:

Pet's Name*

Pet's Sex*
SelectMaleFemale

Species*

Pet's Age*

PRIVATE CREMATION OPTIONS: I do certify, that to the best of my knowledge, the said pet has not bitten any person or animal during the last (10) days and has not been exposed to rabies.*
Yes, I want my pet's remains privately cremated.No, I do not want my pet's remains privately cremated.

PRIVATE CREMATION (continued): If you have selected a private cremation for your pet, please enter the date on when you would like your pet's remains returned to you.

OTHER CREMATION OPTIONS
Ashes will be returned to Aliante Animal Hospital in approximately 7-10 business days for an additional cost to be paid directly to cremation company. Please ask for a brochure at the front desk. Your pet can be held for up to 14 days for you to contact the cremation company at which time your pet will be changed to communal cremation and you will no longer be able to receive the ashes. You will then be billed the charges for a communal cremation.

COMMUNAL CREMATION: Ashes will be spread respectfully in a non-visitable outdoor setting. The cost is $40.00 (+ additional service fees) to be paid to Aliante Animal Hospital.
Yes, I want a communal cremation for my pet.No, I do not want a communal cremation for my pet.

REMEMBRANCE PAW: A keepsake with paw print and photo holder (+ $35).
Yes, I want a remembrance paw.No, I don't want a remembrance paw.

HOLDING REMAINS: Body will be held at Aliante Animal Hospital at no charge for 24 hours. After that time, there will be an automatic charge of $25.00 per day.*
Yes, please hold my pet's remains.No, please do not hold my pet's remains.

Client Signature*

Today's Date*