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Cremation Consent Waiver

Thank you for giving us the opportunity to care for your pet(s)! Please complete the following to the best of your knowledge.

CLIENT INFORMATION

Address:

Phone:

PATIENT INFORMATION:

Cause of death? (Please include a description of signs prior to passing)

CONSENT:

CONSENT:
A

CREMATION CONSENT

Please read carefully and select one:

1. Private Cremation

1. Private Cremation
A

2. Group Cremation

2. Group Cremation
A

3. Take Home

3. Take Home
A
Please select one:
Please select an urn style if you have chosen private cremation.

Rabies Consent

Has your pet bitten anyone within the last 10 days?

Has your pet bitten anyone within the last 10 days?
A
B
If YES, please read the following:
The patient has bitten someone within the last 10 days...

Signature of Owner/Responsible agent

Signature

Date:

PAW PRINT

Would you like a paw print free of charge?
PAW PRINT
A
B
Additional Memorial Paw Prints are available for a fee of $12.61.